FIXED APPLIANCEFIXED APPLIANCE Prepared byPrepared by

Dr. Hana Omar AL. Balbeesi Dr. Hana Omar AL. Balbeesi

Orthodontic consultantOrthodontic consultant

Fixed Appliances :Fixed Appliances :

Are appliances attached to the teeth Are appliances attached to the teeth surfaces &are capable to generate a surfaces &are capable to generate a range of tooth movement more than RA.range of tooth movement more than RA.

Brackets + Arch wires Brackets + Arch wires {generate force that can move teeth in {generate force that can move teeth in

three planes of space vertically , apically three planes of space vertically , apically & rotationally }.& rotationally }.

Edge WireEdge Wire

Brackets : Brackets :

Fixed appliances achieve Fixed appliances achieve tooth movement in 3 spatial tooth movement in 3 spatial planesplanes First-order bends.First-order bends. Compensate Compensate

tooth widths.tooth widths. Second-order bends .Second-order bends . Achieve Achieve

correct angulations or tilt of correct angulations or tilt of the tooth.the tooth.

Third-order bends .Third-order bends . Only for Only for rectangular arch wires. It exert rectangular arch wires. It exert bucco-lingual force on the bucco-lingual force on the tooth apex to torque it .tooth apex to torque it .

Indications for the use of Indications for the use of FA:FA:

1.1. Correction of mild to Correction of mild to moderate skeletal moderate skeletal discrepancies.discrepancies.

2.2. Intrusion/extrusion of Intrusion/extrusion of teeth .teeth .

3.3. Correction of rotations .Correction of rotations .

4.4. Overbite reduction . Overbite reduction .

5.5. Multiple tooth movement . Multiple tooth movement .

6.6. Closure of extraction Closure of extraction spaces ,or spaces due to spaces ,or spaces due to hypodontia .hypodontia .

FA FA close the spaces + close the spaces + produce good contact produce good contact between teeth.between teeth.

Patient selection:

1.1. Patient maintain good oral Patient maintain good oral hygiene .hygiene .

2.2. Avoid hard or sticky food .Avoid hard or sticky food .

3.3. Cooperative patient .Cooperative patient .

4.4. Attend appointments Attend appointments regularly to adjust the regularly to adjust the appliance .appliance .

Components of fixed Components of fixed appliance : appliance :

1.1. Bands :Bands : a.a. Seated on molars or any tooth Seated on molars or any tooth

especially in crossbites .especially in crossbites .

b.b. Headgear can be used with them . Headgear can be used with them .

c.c. Separation is a must . Separation is a must .

d.d. Approximate the size in a study Approximate the size in a study models . models .

e.e. The edges should be The edges should be flushed with marginal flushed with marginal ridges . ridges .

f.f. Bracket in the midpoint Bracket in the midpoint of the clinical crown or 90 of the clinical crown or 90 % to the long axis of the % to the long axis of the tooth .tooth .

g.g. Glass ionomer is used . Glass ionomer is used .

2.2. Bonds :

a.a. Acid etch and composite is Acid etch and composite is used .used .

b. b. Mechanical interlock Mechanical interlock between bracket mesh & the between bracket mesh & the composite .composite .

c. c. They are made of metal or They are made of metal or ceramic .ceramic .

Disadvantages of Ceramic Disadvantages of Ceramic Brackets:Brackets:

1.1. Chemical bond between bracket & Chemical bond between bracket & enamel surface causing tooth Fx during enamel surface causing tooth Fx during debonding .debonding .

2.2. Brittle they break easily & wings breaks, Brittle they break easily & wings breaks, so tying of the wire is very difficult .so tying of the wire is very difficult .

3.3. Hardness of it cause notching of the arch Hardness of it cause notching of the arch wire which make sliding of teeth wire which make sliding of teeth difficult .difficult .

4.4. Wearing of opposing teeth not advisable Wearing of opposing teeth not advisable to be used in the lower incisors . to be used in the lower incisors .

3.3. Orthodontic Orthodontic adhesives :adhesives :

a.a. Cementation with glass Cementation with glass ionomer because it can ionomer because it can release fluoride & better release fluoride & better affinity to stainless steal & affinity to stainless steal & enamel surface .enamel surface .

b.b. Bonding with composite is Bonding with composite is better than glass ionomer .better than glass ionomer .

c.c. Light-cure or self-cure Light-cure or self-cure acrylic resin .acrylic resin .

d.d. No mix-orthodontic No mix-orthodontic composite .composite .

e.e. Despite any material Despite any material used excess should be used excess should be removed . removed .

4.4. AuxiliariesAuxiliaries : :

a.a. Elastomeric modules are easier to place Elastomeric modules are easier to place & more comfortable to the patient .& more comfortable to the patient .

b.b. Ligatures are better in the late stages Ligatures are better in the late stages of treatment . of treatment .

c.c. Intra-oral elastics in 2, 3.5, & 4.5 oz Intra-oral elastics in 2, 3.5, & 4.5 oz strengths & a variety of sizes 1\8 or 3\4 strengths & a variety of sizes 1\8 or 3\4 inches changed every day .inches changed every day .

d.d. Palatal & lingual arches ,quad helix Palatal & lingual arches ,quad helix some are preformed or made in the some are preformed or made in the laboratorylaboratory..

5.5. Arch wires :Arch wires :

Presented in different cross Presented in different cross sectional diameters , &/or sectional diameters , &/or different material constructiondifferent material construction

a.a. Flexible wires in initial stages Flexible wires in initial stages or alignment stage .or alignment stage .

b.b. Rigid wires in the late stages Rigid wires in the late stages of treatment .of treatment .

Arch Wires Physical Arch Wires Physical Properties :Properties :

1.1. Spring back :Spring back : wire returns wire returns to original shape & resist to original shape & resist deformation .deformation .

2.2. Stiffness :Stiffness : greater diameter greater diameter stiffness . stiffness .

3.3. Formability :Formability : bending of the bending of the wire to any desirable wire to any desirable shape .shape .

4.4. Resilience : Resilience : the stored the stored energy after deflection energy after deflection without deformities .without deformities .

5.5. Biocompatibility .Biocompatibility .6.6. Joinability :Joinability : if the material if the material

can be soldered or welded .can be soldered or welded .7.7. Frictional characteristicsFrictional characteristics::

wires with low surface wires with low surface friction is preferred .friction is preferred .

Types of wires :Types of wires :

1.1. Stainless steal :Stainless steal : preferred preferred in later stages of in later stages of treatment (multi-strand & treatment (multi-strand & or twistflex ).or twistflex ).

2.2. Nickel titanium :Nickel titanium : more more flexible , greater flexible , greater resistance to deformation resistance to deformation but expensive .but expensive .

3.3. Cobalt chromiumCobalt chromium (can be (can be readily formed & R & S readily formed & R & S by heat ).by heat ).

4. 4. TMA or B-Titanium .TMA or B-Titanium .

5.5. They are either They are either roundround (0.016 = 0.4 mm) or (0.016 = 0.4 mm) or rectangularrectangular (0.016 (0.016 ×× 0.022 0.022 = 0.4 = 0.4 ×× 0.55 mm, can be 0.55 mm, can be straight straight or or coilcoil in in a spoola spool or or preformed .preformed .

Treatment planning for Treatment planning for fixed appliances :fixed appliances :

1.1. AnchorageAnchorage is important is important headgear &/or a palatal headgear &/or a palatal or lingual arch should be or lingual arch should be placed .placed .

2.2. Lower arch form should be Lower arch form should be preserved .preserved .

Practical Practical procedures :procedures :

1.1. Pre-adjusted system brackets will be Pre-adjusted system brackets will be in the middle of the tooth along the in the middle of the tooth along the long axis .long axis .

2.2. Improper bracket position Improper bracket position incorrect tooth position,& affect incorrect tooth position,& affect function & esthetics .function & esthetics .

3.3. Mesiodistal movement of the teeth Mesiodistal movement of the teeth can be achieved by sectional or can be achieved by sectional or sliding teeth along the arch wire .sliding teeth along the arch wire .

4.4. Patient should be seen every 4-6 Patient should be seen every 4-6 weeks.weeks.

Fixed Appliance Fixed Appliance System :System :

1.1. Pre-adjusted appliance or Pre-adjusted appliance or straight wire appliance straight wire appliance (Andrews’ & Roth (Andrews’ & Roth systems are the best) .systems are the best) .

2.2. Begg appliance .Begg appliance .3.3. Tip edge appliance .Tip edge appliance .

Tip edge appliance Tip edge appliance :: It combines the advantages of It combines the advantages of

both Straight Wire & Begg both Straight Wire & Begg systems .systems .

It allows tipping of the tooth in It allows tipping of the tooth in the initial stages with round the initial stages with round wires & better tooth positioning wires & better tooth positioning in the final stages with in the final stages with rectangular arch wires . rectangular arch wires .

Decalcification of fixed Decalcification of fixed appliance :appliance :

Fixed appliance plaque Fixed appliance plaque accumulation accumulation

demineralization by 15-85 demineralization by 15-85 % .% .

Approaches to Reduce Approaches to Reduce DecalcificationDecalcification

1.1. Fluoride mouth rinses Fluoride mouth rinses regularly.regularly.

2.2. Fluoride containing cements Fluoride containing cements & bonding adhesives .& bonding adhesives .

3.3. Dietary advise chewy Dietary advise chewy sweets, sugared beverages sweets, sugared beverages & fizzy drinks between meals & fizzy drinks between meals should be avoided during should be avoided during treatment .treatment .

Starting with Fixed Starting with Fixed Appliance Appliance

Skillful orthodontist :Skillful orthodontist :

Knowledge with diagnosis & Knowledge with diagnosis & treatment planning before treatment planning before treating any patient .treating any patient .

TTHHAANNKK YYOOUU