Fixed Orthodontic Appliances

FIXED ORTHODONTIC APPLIANCESDr. Murad

Removable vs. Fixed AppliancesREMOVABLETipping onlyNo control over root movementPts co-operationHygienicFIXEDBodily translationControl of root movementLess dependent on pts co-opLess hygienic

DEVELOPMENT OF FIXED ORTHODONTIC APPLIANCES

Development of Fixed appliances

Early fixed appliances Late 1800sEdward Angle

EARLY FIXED APPLIANCES

Development of Fixed appliancesStandard Edgewise appliance Early 1900s

Development of Fixed appliances

Pre-adjusted edgewise appliance 1970sRefined manufacturing process with built-in adjustments specific for each toothAdvances in material sciences made attachment much smaller

BANDED APPLIANCES

Bonding to Enamel

Bonding Surface - Bracket Base

BONDED APPLIANCES

Lingual Appliance

CERAMIC APPLIANCES

Self Ligating Appliance

PASSIVE FIXED APPLIANCES

Components of the Fixed ApplianceBandsMolar TubesBracketsBuccal TubesArch WiresAuxiliaries: Elastomeric products, Coil springs, Lingual arches, Extra-oral appliances

Posterior attachmentsMOLAR TUBES

Components of the Fixed ApplianceBandsMolar TubesBracketsArch WiresAuxiliaries: Elastomeric products, Coil springs, Lingual arches, Extra-oral appliances

Anterior AttachmentsBrackets

ARCH WIRESMaxillary and mandibularArch form described as parabolic shaped Size and cross-section of wires varyMaterial varies eg. Nickel Titanium alloy (NiTi), Titanium Molybdenum Alloy (TMA), Stainless Steel

Elastics

EXTRA ORAL FORCES - HEAD GEAR

Coil SpringClosed or open coil springs

Pre-Adjusted Edgewise Appliance or The Straight Wire Appliance

Larry Andrews - studied normal occlusion and individual tooth positionsDeveloped prescriptions for individual tooth positionElements of ideal tooth position are built into the applianceMinimizing active wire manipulation - The Straight Wire Concept

Pre-adjusted edgewise applianceFirst order / in-out - Horizontal planeSecond order / tip - Mesio-distal angulationThird order / torque - Labio-lingual angulation

3 - Dimensional control of tooth position

First order or In-out

Second order or Tip

Third order or TorqueTo Torque is the least efficienttooth movement using orthodonticappliances

Significance of accurate bracket/band positioningPrecise tooth positioningOptimal effect of pre-adjustmentOcclusionEstheticsStability

POSITIONING BRACKETS - GENERAL INSTRUCTIONSRhomboidal shapeDisto-lingual wing markCentral scribe line (long axis)

Maxillary Central Incisors4

Distance from the slot to the incisal edge = 4mm

From the occlusal, the bracket is centered mesio-distally.

As a guide, approximate the incisal edge of the incisor with the base of the bracket perpendicular to the clinical crown long axis.

Maxillary Lateral Incisor3.5

Distance from the slot to the incisal edge = 3.5mm

Maxillary Cuspids4.5 mm

Distance from cusp tip to bracket slot = 4.5 mm

The severe angulation and prominent anatomy of cuspids (10o) can make placement difficult

From the occlusal view, the bracket is centered mesio-distally on the prominent buccal developmental ridge. This also corresponds to the clinical crown long axis. This will usually be mesial to the center of the contacts

Maxillary Bicuspids

Distance from cusp tip to bracket slot = 4 mm

From the occlusal view, the bracket is centered mesio-distally on the prominent buccal developmental ridge. This also corresponds to the clinical crown long axis.

Mandibular Incisors

Mandibular Cuspid

Mandibular Bicuspids

Maxillary first molar bands

Mandibular first molar bands

Palmer notation used in Orthodontics

Right

Left

Upper

7

6

5

4

3

2

1

1

2

3

4

5

6

7

Upper

Tooth #

2

3

4

5

6

7

8

9

10

11

12

13

14

15

Tooth #

31

30

29

28

27

26

25

24

23

22

21

20

19

18

Lower

7

6

5

4

3

2

1

1

2

3

4

5

6

7

Lower

The bracket height chart is written in Palmer Notation. This notation numbers the teeth starting with the central incisors as 1. The laterals are then 2. The canines are 3. The 1st and 2nd premolars are 4 and 5 respectively, the 1st molars are 6 and the 2nd molars are 7.

Bracket Heights from Cusp tip or Incisal Edge

Right

2nd M

1st M

2nd B

1st B

Cu

LI

CI

CI

LI

Cu

1st B

2nd B

1st M

2nd M

Left

Upper

7

6

5

4

3

2

1

1

2

3

4

5

6

7

Upper

Bracket height

3.5

4

4

4

4.5

3.5

4

4

3.5

4.5

4

4

4

3.5

In mm

Occ

plane

(

Bracket

height

3.5

4

4

4

4.5

4

4

4

4

4.5

4

4

4

3.5

In mm

Lower

7

6

5

4

3

2

1

1

2

3

4

5

6

7

Lower

Documents

Fixed Orthodontic Appliances