Ortho Fixed Appliance

8/19/2019 Ortho Fixed Appliance

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FIXED ORTHODONTIC APPLIANCES

Prepared and Presented By:

Musab A.ra!an


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DEFINITION:

Are attachments that are fxed to the tooth

surace, the orces are exerted via theattachments using arch wires and/or other

auxiiaries thus are ca!a"e o greater range o

movements than that o the remova"e ones#

It cannot "e ad$usted neither removed "% the

!atients


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AD&ANTA'E(:

Precise tooth control

Is !ossi"e "ecause its !ossi"e to move theteeth in ) !anes o s!ace so achieving!erect aignment o teeth "oth inter and intraarch


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Multiple tooth movement are possible:

*#Individua tooth can "e moved in ) !anes os!ace simutaneous% e#g: a tooth can "eintruded and retracted simutaneous%

+#Dierent teeth can "e moved at the sametime in dierent directions e#g one can "ederotated whie the other is retracted


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Patient cooperation is reduced com!ared to

that o the remova"e a!!iance


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DI(AD&ANTA'E(

Oral hygiene requirements:

It "ecomes diicut as the ood de"ris tends to

accumuate around the attachments


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Esthetics:

Fixed a!!iances are genera% made out o

metas so not esthetica% acce!ted "% most!atients# The advent o ingua techni-ue andtooth coored "rac.ets have he!ed toovercome this advantage so ar#


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Requires special training for the operator

athough sim!e cases can "e done "% a '01 Expensive


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Increases the chair side time:

(ince its fxed and cant "e removed "% the

!atient a the modifcations and ad$ustmentsshoud "e done "% the dentist

(o increasing the time


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Anchorage control is diicut com!ared to

that o the remova"eTtt monitoring is diicut as the !atient

must "e recaed in reguar visits or

ad$ustments/reactivators


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Fixed orthodontic a!!iances are indicated

whenever muti!e tooth movement is re-uired:


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orrection of mild to moderate s!eletal

discrepancies As fxed a!!iances can "e usedto achieve "odi% movement it is !ossi"e,

within imits, to com!ensate or s.eeta

discre!ancies and treat a greater range o

maoccusions#


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Intrusion"extrusion of teeth &ertica

movement o individua teeth, or toothsegments, re-uires some orm o attachment on

the tooth surace onto which the orce can act#

orrection of rotations


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Overbite reduction "% intrusion o incisors

Multiple tooth movements re-uired in one

arch

Active closure o extraction s!aces, or

s!aces due to h%!odontia Fixed a!!iances can

"e used to achieve "odi% s!ace cosure and

ensure a good contact !oint "etween the teeth


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2ONT3AINDI2ATION(

:

Poorly motivated patient:

As the !atient4s res!onsi"iit% os not imited to

maintaing a good ora h%giene "ut wi asoinvove eastic and headgear wearing and.ee!ing a!!ointments at reguar intervas


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Poor dental health:

!atients with !oor denta h%giene are i.e% to

suer rom !eriodonta deiseases


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Malocclusions beyond the scope of #OA

e#g s.eeta $on specifcialists, on% orthodontists are

-uaifed to im!art ttt using FOA


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2O50ONENT(:

Active

passive


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A2TI&EThese incude com!onents which are ca!a"e

o generating tooth moving orces# These

incude:a# (e!arators # 5agnets

"# Archwires

c# Eastics

d# Eastomerics

e# (!rings


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(e!erators are used to create s!ace "etween

+ ad$acent teeth genera% to "and them6as severa t%!es:


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73A(( 8I3E

Initia sot "rass wire 9# to 9#;mm !assed

interdenta% and twistedThe% were !ainu, caused acerations due to

the uncontroed orced


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7rass se!arators in

!ace media anddista to the maxiar%et frst moar


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=E((IN'

(E0E3ATO3

are made o 9#9*;? s!ecia !us Austraian

wire with heices at the cosed end# The o!enstraight arm !asses "eow the contact

suicient s!ace is created within @ hours o

a!!ication


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The short arm othe se!arator ished in a

8eingart !ier

The ong, hoo.edarm is !aced

under thecontact !oint andthe short arm is!ued atera% "%the !ier


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The se!arator is rotated into !ositionwith the ong,hoo.ed arm o the se!arator over thecontact !oint and theshort arm under the contact !oint


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3IN' (E0E3ATO3(

Are sma eastic rings that are stretched and

!assed through the interdenta contacts using

se!arators4 !acing !ier


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Easticse!arators# Theose ones have

a rectanguarcut sectionwhereas theones on thestic. are round

0acement o eastomericse!arators using dentaoss# Two !ieces o oss are!aced through the hoe in thecenter o the se!arator and arehed one in each hand


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The se!aratorB

!acing !ier

(nug% ftting eastic

se!arators


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A326 8I3E(

Are avaia"e in various dimentions and

materias

0h%sica !ro!erties:

%pringbac!: a"iit% to return to its origina

sha!e ater an a!!ied orce


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%ti&ness: amount o orce re-uired to "end

or deect the wire

#ormability : ease in which the wire "ends

into the desired sha!e

Resilience: stored energ% remaining ater

deection w/o !ermanent deormit%


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'iocompatibility

(oint ability : whether the materia can "eweded or sodiered

#rictional characteristics


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CaCr TMA NiTi ss


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T>0E(

%tainless steel

(tainess stee is an ao% consisting o iron, chromium and

nic.e, which has a arge moduus o easticit%# As such, stainess

stee archwires are genera% sti and resist deormation, which

ma.es them idea as wor.ing archwires, exi"iit% o stainess

stee archwires can "e increased "% winding severa smaer

wires together to orm arge mutistrand or twistex wiresC or

wra!!ing smaer wires around a arger centra wire to !roduce a

coaxia wire


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obalt chromium

2ommercia% mar.eted as Egio%, co"at chromium

has a greater orma"iit% than stainess stee andsimiar stiness, "ut with greater riction# It can "ehardened "% heatBtreating in the a"orator% and isused or the construction o auxiiaries, such as anintrusion arch or -uadheix#


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'eta titanium

Introduced in the *G9s, "eta titanium wires have

good orma"iit%, with a stiness o around oneBthirdthat o stainess steeC "ut the% are aso associatedwith higher

riction# These archwires are used in the f na stageso treatment, when fnishing "ends ma% "e re-uiredto detai individua tooth !osition and achieve

setting o the occusion#


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$ic!el titanium

Nic.e titanium or H NiTi 4 archwires are

characteried "% high exi"iit% and the deiver% oow orce over ong range# The% aso exhi"it the!henomenon o sha!e memor%C when deormed the%wi tend to return to their origina sha!eC andsu!ereasticit%, the wire deivering the same orceover a arge range o deormation


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These wires are idea or aigning teeth during theinitia stages o treatment# 6owever, the !ro!erties

o ow stiness and !oor orma"iit% ma.e nic.etitanium an unsuita"e materia or ater stages otreatment where a stier archwire is re-uired ors!ace cosure and over"ite contro#


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E


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classI :

Are intra arch main% !aced "etween the

moars and incisors in the same arch to cosethe extraction s!aces "% retracting anteriorteeth or !rotracting the !osterior


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2ass I eastics, the horionta%!aced greeneastics seen in the a"ove and"eow !hotogra!hs


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classII :

Are intermaxiar% !aced "etween mandi"uar

moars and maxiar% anteriors, can "e used to!roduce intrusion o max# anterior 7eggthera!% stage*1 or decrease the over$et "%retraction o the max# anterior


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2ass II eastics are!aced "etween the

mandi"uar moars andthe maxiar% anteriors


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lass III :

Are intermaxiar% !aced "etween maxiar%

moars and mandi"uar incisors, genera% inthe TTT o ange cass III maoccusions


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2ass III eastics


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)iagonal elastics:

8orn or midine deviation correction


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6orionta !in. coored

eastics are 2ass I eastic


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ross*bite elastics

Are intermaxiar% and used to correct cross

"ite in the "ucca segment and !acedaccording to the tooth in cross "ite, genera%rom the !aata surace o the maxiar% moarsor !remoars to the "ucca o the ower moarsor !remoars


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2ross "ite eastics


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'ox elastics: used to correct the anterior

o!en "ite, the% extend "etween max# and man#

2ausing the dista ti!!ing o the maxiar%

anterior and/or orced eru!tion o max# and/or

mand anteriors


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7ox eastic


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Extra*oral elastics: are used in con$uction

with extraBora a!!iances i.e a ace mas.

It usua% exerts high orces 9#G to *@ o1


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ExtraBora eastics


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E


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Elastic thread or cotton thread:

5ade rom s!ecia t%!e o cotton and are used

to correct the deBrotations, consoidation oanterior s!ace


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Figure o G !acement o the cotton thread


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Elastic ligature:

Jsed to secure the arch wires in edgewise or

!re ad$usted edgewise "rac.ets#


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Elastic modules or elastic lin!s

Are made o + eastic rings se!erated "% a

varia"e distance, avaia"e in dierent sies

"ased on the interBring distances, are genera%

used to cose s!aces or deBroation o anterior

teeth


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(03IN'( &arious t%!es o s!rings are used as auxiiariesto generate tooth moving orces, are main%used or tooth u!Brighting and tor-ueing in

"eggs a!!iance thera!%, ti! edge a!!iances#(!ring ma%"e used to o!en s!aces o!en cois!ring1 or cose s!aces cosed coi s!ring1

6as the oowing t%!es:


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+p righting springs:

5ade o 9#9*+44 or 9#9*@44 Austraian wire,

the% move the tooth root in a mesia or dista

direction

5esiodistau!rightings!rings


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Rotating spring: !rovides or a sim!e and

eective means or deBrotating teeth without the

remova o the arch wire, the% are ca!a"e o

coc.wise or anticoc.wise motion according to the

design

3otatings!rings


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Torquing spring:

2a!a"e o moving the root a"ia/ingua or !aata

in direction, the orce is generated when the s!ring

is deormed and engaged aong the arch wire

Tor-uing s!ring used or"uccoinguaroot movement


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'oodman Tor-ueing (!ring


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Open coil spring:

Are either made o (( or NiTi ao%s# The orce

exerted de!ends on the diameter o the wire o

which its made o, its used s!ring o a!!ro!riate

ength is com!ressed "/w + or more teeth to o!en u!

its !oints o attachment


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O!en coi s!ring in !ace


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losed coil spring:

5ade o stainess stee or nic.e titanium ao%s#

The% are used to cose s!aces# Once the s!ring isstretched and attached at two ends, it tries toachieve its !rea"ricated ength "% cosing the ga!"etween its !oints o attachment

2osed coi s!ring stretched rom themoar, !remoars to canine "rac.etor the retraction o the canine


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0A((I&E

Are those com!onents which are not ca!a"e o

generating tooth movement orces "ut he! in

!roviding attachments or other auxiaries to the

tooth or retaining other active com!onents

AB7ands

7B7rac.ets

2B7ucca tu"es


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DB ingua attachments "uttons, seating ugs, ceats,sheaths, "a hoo.1

EB oc. !insFB igature wires


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7AND(

Are either costume a"ricated or commercia%

made sies

Are meta attacments encirces the tooth1 that are

cemented and !rovides a !ace or attachments o

other auxiaries which can "e either weded or

soidered to the "and


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Indications:*Bteeth that wi receive heav% intermittent orcesagainst the attachments !rimar% indication1 e#gu!!er *st moar against extraora orces wi "e!aced via a head gear


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+B teeth that wi need "oth a"ia and inguaattachments e#g a moar with "oth headgear andingua arch wires

)B teeth with short cinica crowns


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(te!s o "anding:

-Step I Separation of adjacent teeth:

can "e achieved using se!arators or a duration o +to K da%s de!ending u!on the se!arator used#


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-Step II Selection of band material

Thinner "and materia esser in width is used or

anterior 9#9*9 L )#G9mm1 teeth and thic.er "andmateria "roader in width is used or !remoars 9#*+L @# mm1 and moars 9#* L @#mm1#


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-Step III Pinching the band

7and materia o ade-uate ength is cut and wededat the ends


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The "and is ada!ted around the teeth using a "and!usher and

!inched using the "and !inching !iers or a 6owe!ier


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The !inched "and is removed rom the tooth andweded cose to the !inched ends# Extra "andmateria is cut and "ent in a dista direction andweded


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The margins are smoothered and gingiva contouringdone on the mesia and dista gingiva margins usinga denta stone


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-Step IV i!ing the attachments

Attachments can "e weded or sodered in !ace#8eding is more common% !erormed


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-Step V Cementation of the band can be done"sing an# of

the uting cements# Ade-uate moisture contro isessentia during cementation# Excess cement can "eremoved using an ex!orer ater the initia set o theuting cement


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73A2=ET(

defned as a device that !ro$ects horionta% to

su!!ort auxiiaries and is o!en on one side usua% in

the vertica or horionta


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7rac.ets are o various t%!es de!ending u!on the

techni-ue used# 7rac.ets can either "e weded to

"ands which are then cemented to individua teeth

or can "e "onded# 7onding has its own inherent

advantages and disadvantages over "anding


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Edge,ise brac!ets

Edgewise "rac.ets have rectanguar sots, which are dee!er in the

horionta as o!!osed to vertica !ane# (ot and archwire dimensions have

traditiona% "een descri"ed em!irica%, with the origina dimensions

"eing 9#9++ inches vertica% and 9#9+G inches horionta% to

accommodate god archwires, which were -uite sot# Once stier stainess

stee archwires were introduced, sot sie was reduced to 9#9*G inches

vertica% and 9#9+ inches horionta%# 6owever, with greater u!ta.e o

!reBad$usted edgewise s%stems, there has "een a move "ac. to the

origina sot dimension#


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This aows increased dimensions o the wor.ing archwire and !rovides

"etter over"ite and tor-ue contro during s!ace cosure with siding

mechanics# Edgewise "rac.ets are a"ricated with a singe archwire

channe and two tieBwings or more common% as (iamese or twin "rac.ets,

which have our tieBwings# (iamese designs have an increased "rac.et

width, which !roduces "etter contro o tooth rotations and root !ositionC

whist the !resence o two se!arate tieBwings aows !artia igation o

crowded teeth during initia aignment# 6owever, the increased width o

(iamese "rac.ets resuts in a reduced inter"rac.et s!an and somecom!romise in exi"iit% o the archwire during ear% aignment#


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Edgewise "rac.ets Edgewise a!!iance


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Fu% "anded standard edgewisea!!iances with s!aceBcosing oo!s

in the u!!er and ower archwires

read$usted edgewise a!!iance#


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-ight ,ire appliance brac!ets

The origina ight wire a!!iance was the 7egg

a!!iance, which utiied a sim!e "rac.et that wasidentica or each tooth# 7egg "rac.ets incor!orate anarrow o!enended sot, into which a sti roundarchwire is !aced rom the gingiva as!ect and hedin !osition "% the insertion o a sma metaicauxiiar% oc. !in


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7egg "rac.et


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%elf*ligating brac!ets

In an attem!t to reduce riction and a!!ointment

times, a range o "rac.ets whose sot is cosed "% theuse o a meta gate or ci! are now avaia"e # Thistechni-ue is reerred to as seBigation, as theigation s%stem is "uit into the "rac.et


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seBigating "rac.et with the gatecosed et1 and o!en right1#


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'uccal Tubes 7ucca tu"es are horionta

hoow tu"es, round, rectanguar or ova in sha!e#

The% are genera% used on moars and he! !rovide

"etter three dimensiona contro o these anchor

teeth# The% can "e cassifed as:

a# 2assifcation "ased on mode o attachment

M 8eda"ecan "e weded onBto "andsM 7onda"e"onded direct% to the tooth surace


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8eda"e moar tu"es

7onda"e moar tu"es


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"# 2assifed according to umen sha!e as

M 3ound

M OvaM 3ectanguar

c# According to the num"er o tu"es

M (inge


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M 7egg tu"e, round or ova

M Edgewise tu"e rectanguar 9 ti! and tor-ue vaues

M 0read$usted edgewise rectanguar with !rescri"edinBout, ti! and tor-ue vaues


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3ound moar tu"e Ova moar tu"e

3ectanguar tu"e


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(inge moar tu"e

Dou"e moar tu"e Edgewise1,

!reBad$usted edgewise1


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-ingual Attachmentsare accessor% attachments other than "rac.ets and tu"eswhich are !aced on the ingua as!ect o teeth "onded1 or

"ands weded1#These incude:

-ingual buttons: varia"e sha!ed "ases or

attachment o eastics or eastomerics# Fat "ase or

centering on moars, curved or mesia or dista !acementon moars or extraBcurved or use on !remoars


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7onda"e ingua "uttons


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-ingual seating lugs: These he! in seating o

"ands# Are at or anteriors and moars and curved

or cus!ids and "icus!ids#


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-ingual eyelets: These are used to tie eastic

threads or igature wires# 6oow in the midde and

weded on the two sides#

Eas%Bthreading e%eets


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-ingual cleats: These are again used or

attachment o eastics or eastomerics# Are weded in

the midde with the ends "eing o!en, are aso

avaia"e with a mesh "ase or "onding

&ersatie !recision ceats


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-ingual sheaths: are used or attaching

accessories such as trans!aata arches, NiBTi moar

rotators and ex!anders


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-ingual elastilugs: are used or attaching

eastics and are avaia"e as curved or !osteriors

and at or anteriors# 7oth weda"e and "onda"e

ugs are avaia"e

Eastiugs


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-ingual ball hoo!: These are sma "as

attached to a weda"e at arm# The oset can "e

mesia or dista# The% are used to attach eastics or

eastomeric chains/rings rom the ingua as!ect


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$oc% Pins

are either made o "rass or sot stee# These are

used to hod the wire in "rac.et sots in the 7egg

techni-ue or accessories in the ti! edge techni-ue#


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-igature .ires:


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T6AN= >OJ


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# 5agnets

Documents

Ortho Fixed Appliance