ORTHODONTIC ORTHODONTIC APPLIANCESAPPLIANCES

214 DDA214 DDA

DEFINITIONDEFINITION

Orthodontic appliance is a Orthodontic appliance is a device that is used to device that is used to produce changes in the produce changes in the relationships of the teeth relationships of the teeth and the skeletal structures. and the skeletal structures.

TYPES OF ORTHODONTIC TYPES OF ORTHODONTIC APPLIANCESAPPLIANCES

REMOVABLE .REMOVABLE . FIXED .FIXED .

REMOVABLE REMOVABLE APPLIANCESAPPLIANCES

They are designed to be They are designed to be placed & removed by the placed & removed by the patient as directed by the patient as directed by the orthodontist.orthodontist.

TYPES OF TYPES OF REMOVABLE REMOVABLE APPLIANCESAPPLIANCES

1.1. INTRAORAL .INTRAORAL .

2.2. EXTRAORAL .EXTRAORAL .

1. INTRAORAL 1. INTRAORAL APPLIANCESAPPLIANCES

Types are Either Types are Either I.I. Removable such as :Removable such as : 1. Functional appliances.1. Functional appliances. 2. Active retainers.2. Active retainers. 3. Passive retainers & 3. Passive retainers &

positionerspositioners.. OROR II.II. Fixed :Fixed : Space maintainers.Space maintainers.

FUNCTIONAL FUNCTIONAL APPLIANCEAPPLIANCE

Is a removable device that is Is a removable device that is frequently used during growth to frequently used during growth to correct skeletal imbalance and correct skeletal imbalance and produce changes in the produce changes in the differential growth rate , before differential growth rate , before placement of fixed appliances . placement of fixed appliances .

ACTIVE RETAINERSACTIVE RETAINERS

Are used to achieve Are used to achieve minor tooth movement minor tooth movement (tipping movement) .(tipping movement) .

RETAINERS & RETAINERS & POSITIONERSPOSITIONERS

Are removable appliances Are removable appliances that are used to hold or that are used to hold or retain alignment of the retain alignment of the teeth after fixed appliance teeth after fixed appliance therapy.therapy.

SPACE MAINTAINERSSPACE MAINTAINERS

Are constructed to Are constructed to maintain the spaces for maintain the spaces for the permanent teeth after the permanent teeth after deciduous teeth loss .deciduous teeth loss .

2. EXTRAORAL 2. EXTRAORAL APPLIANCESAPPLIANCES

It is an appliance that is worn It is an appliance that is worn outside the mouth to gain force outside the mouth to gain force from the head & neck to change from the head & neck to change the differential growth rate.the differential growth rate.

EX:EX:

Headgear Headgear

HEADGEARHEADGEARIs an orthopedic device that can be Is an orthopedic device that can be

used in conjunction with fixed or used in conjunction with fixed or removable appliances ,it is used to removable appliances ,it is used to control growth & tooth movement.control growth & tooth movement.

It is made of tow parts :It is made of tow parts :

Facebow & the traction device .Facebow & the traction device .

Facebow :Facebow :

* * It is used to stabilize or move It is used to stabilize or move the maxillary 1the maxillary 1stst molar distally to molar distally to create more space in the arch.create more space in the arch.

** It has an intra & extra oral It has an intra & extra oral parts ,the intra will fit into the parts ,the intra will fit into the buccal tube of the maxillary 1buccal tube of the maxillary 1stst molar .The outer part of the bow molar .The outer part of the bow attaches to the traction device . attaches to the traction device .

• Traction Traction DeviceDevice

It applies the extraoral force used It applies the extraoral force used to achieve the desired Tx results . to achieve the desired Tx results .

It has four types :It has four types :

High pullHigh pull , ,cervicalcervical , ,combinationcombination & & chin capchin cap . .

HIGH PULL :HIGH PULL : It is a caplike It is a caplike device that fits around the pt device that fits around the pt head &hooks perpendicular to head &hooks perpendicular to the occlusal plane. It is used to the occlusal plane. It is used to control growth of the maxilla control growth of the maxilla or retraction of anterior teeth.or retraction of anterior teeth.

Cervical pull :Cervical pull : It fits around It fits around the pt’s neck. The exerted the pt’s neck. The exerted force is parallel to the occlusal force is parallel to the occlusal plane. It is used to stabilize or plane. It is used to stabilize or distalize the 1distalize the 1stst maxillary maxillary molars molars

Combination :Combination : It is a It is a combination of high pull & combination of high pull & cervical traction devices It cervical traction devices It exerts a force along the exerts a force along the occlusal plane & upward .occlusal plane & upward .

Chin cap :Chin cap : It is a combination It is a combination of high-pull strap & a chin of high-pull strap & a chin cup that fits on the mandible. cup that fits on the mandible. It controls mandibular growth It controls mandibular growth in Cl III patients . in Cl III patients .

FIXED APPLIANCESFIXED APPLIANCES They are attached to the teeth They are attached to the teeth which are removed by the which are removed by the orthodontist.orthodontist. It is called braces.It is called braces. It can move teeth in six It can move teeth in six directions:directions:

Mesially, distally , lingually, Mesially, distally , lingually, facially, apically & occlusally ,as facially, apically & occlusally ,as well as rotationally. well as rotationally.

COMPONANTS OF FIXED COMPONANTS OF FIXED APPLIANCE:APPLIANCE:

1.1. AttachmentsAttachments includeinclude bands bands (esp on 1(esp on 1stst & 2& 2ndnd molars)molars) & & brackets brackets bonded bonded directly to the teeth (esp on anterior directly to the teeth (esp on anterior & premolar teeth) .& premolar teeth) .

2.2. AxillariesAxillaries (attach arch wire to (attach arch wire to brackets &brackets & bands to move teeth such bands to move teeth such asas tubes, hooks & elastics .tubes, hooks & elastics .

3.3. Arch wiresArch wires are attached to the are attached to the brackets by bending the wire it will brackets by bending the wire it will give force & pressure that cause teeth give force & pressure that cause teeth to move in the desired direction . to move in the desired direction .

After decision has been made After decision has been made that fixed appliance should be that fixed appliance should be used Tx plan will be discussed used Tx plan will be discussed & pt will be prepared to & pt will be prepared to receive separators. receive separators.

SEPARATION OF TEETHSEPARATION OF TEETH

SeparatorSeparator is a device that force or is a device that force or wedge the teeth a part so bands wedge the teeth a part so bands can be fitted easily.can be fitted easily.

It involvesIt involves threethree separating separating methods :methods :

Brass wireBrass wire separators ,separators ,steel steel separatingseparating springssprings, &, & elastomericelastomeric separators.separators.

1. ORTHODONTIC 1. ORTHODONTIC ATTACHMENTS ATTACHMENTS

ARE :ARE :

BANDS .BANDS .

BRACKETS .BRACKETS .

BANDS SELECTION:BANDS SELECTION:

-- Bands are preformed stainless steal Bands are preformed stainless steal rings which has to be selected rings which has to be selected properly on diagnostic cast or by properly on diagnostic cast or by visual inspection of the size.visual inspection of the size.

-- They are divided into maxillary & They are divided into maxillary & mandibular (R & L).mandibular (R & L).

CEMINTATION OF CEMINTATION OF ORTHODONTIC BANDSORTHODONTIC BANDS

Cement has to have strength to aid Cement has to have strength to aid in retention with enamel as (zinc in retention with enamel as (zinc phosphate), as well as a time-phosphate), as well as a time-released fluoride to prevent decay released fluoride to prevent decay under the bands as (glass under the bands as (glass ionomer) .ionomer) .

• BRACKETSBRACKETS The most common type is the The most common type is the

edgewise brackets . edgewise brackets . It is made of stainless steal & It is made of stainless steal &

attached to a backing pad ,it has attached to a backing pad ,it has four wings to attach the arch wire four wings to attach the arch wire to it after placing it horizontally . to it after placing it horizontally .

It has auxiliary attachments such It has auxiliary attachments such as headgear tubes ,edgewise as headgear tubes ,edgewise tubes ,labial hooks ,lingual arch tubes ,labial hooks ,lingual arch attachments . attachments .

PREPARATION OF TEETHPREPARATION OF TEETH

Teeth should be polished by Teeth should be polished by pumice & rubber cup to remove pumice & rubber cup to remove pellicle & food debris .pellicle & food debris .

Acid etching will be placed on Acid etching will be placed on the tooth surface for 15 seconds the tooth surface for 15 seconds then washed & dried .then washed & dried .

Monomer agent will be applied on Monomer agent will be applied on the tooth surface as well as the the tooth surface as well as the bracket .bracket .

In addition to the agent the boding In addition to the agent the boding material will be placed on the material will be placed on the bracket only . bracket only .

The bracket pressed on the tooth The bracket pressed on the tooth surface & the excess will be removed surface & the excess will be removed . .

2. ARCH WIRES2. ARCH WIRES It is shaped like a horse shoe ,when It is shaped like a horse shoe ,when

it is tied to the brackets it provides it is tied to the brackets it provides sufficient force to move teeth .sufficient force to move teeth .

It has several types with each has It has several types with each has different properties eg different properties eg Nickel Nickel titanium ,Stainless steal wires .titanium ,Stainless steal wires .

In addition it has different shapes & In addition it has different shapes & sizes sizes (Round ,Square & (Round ,Square & Rectangular).Rectangular).

3. 3. AUXILARIESAUXILARIES It has tow types :It has tow types :

1.1. Ligature wiresLigature wires are twisted around are twisted around the bracket to hold the wire in the bracket to hold the wire in place .place .

Kobyashi hooks Kobyashi hooks has a hook for has a hook for

attachment of elastics . attachment of elastics .

2.2. elastomeric ties elastomeric ties are made of are made of plastic or rubberlike material & plastic or rubberlike material & available in many colors . available in many colors .

3. 3. Power products Power products it can move it can move teeth & the tow commonly used teeth & the tow commonly used types are types are elastic chain tieselastic chain ties (to (to close spaces) & close spaces) & elastics (rubber elastics (rubber bands)bands) from one tooth to from one tooth to another in the same arch or another in the same arch or teeth in opposing arches to teeth in opposing arches to move teeth in certain direction. move teeth in certain direction.

ASSISTANTS ASSISTANTS RESPONSIBILITIES :RESPONSIBILITIES :

1.1. Assistant should check the pt Assistant should check the pt appliance for anyappliance for any

Broken or missing arch wires Broken or missing arch wires Loose brackets & bands Loose brackets & bands Loose or broken or missing ligaturesLoose or broken or missing ligatures Loose or broken or missing elastics .Loose or broken or missing elastics .

2.2. Oral hygiene & dietary Oral hygiene & dietary instruction: instruction: --Should be given to Should be given to avoid food trapment & plaque avoid food trapment & plaque accumulation because bad oral accumulation because bad oral hygiene will lead to rampant hygiene will lead to rampant caries & periodontal disease .caries & periodontal disease .

--Also Also ice ,popcorn ,nuts & sticky ice ,popcorn ,nuts & sticky foodsfoods should be avoided because should be avoided because they will cause band loosening , they will cause band loosening , bracket popping off & arch wire bracket popping off & arch wire bending .bending .

COMLETED COMLETED TREATMENTTREATMENT

When Tx finished the appliance When Tx finished the appliance will be removed & teeth should will be removed & teeth should be cleaned and polished .be cleaned and polished .

All records will be retaken All records will be retaken (Impression , radiographs and (Impression , radiographs and photographs ) .photographs ) .

As well as a removable or fixed As well as a removable or fixed retainer will be constructed . retainer will be constructed .

RETENTIONRETENTION Is necessary to :Is necessary to : Allow gingival & periodontal Allow gingival & periodontal

tissues reorganization .tissues reorganization . Support unstable teeth to Support unstable teeth to

prevent relapse .prevent relapse . Control growth changes . Control growth changes .

TYPES OF RETENTIVE TYPES OF RETENTIVE APPLIANCESAPPLIANCES

1.1. POSITIONERS .POSITIONERS .

2.2. HAWELY RETAINERS .HAWELY RETAINERS .

3.3. LIGUAL RETAINERS .LIGUAL RETAINERS .

1.1. POSITIONERSPOSITIONERSIs a custom appliance made of Is a custom appliance made of

rubber or pliable acrylic that fits rubber or pliable acrylic that fits over the dentition after over the dentition after orthodontic Tx completion . orthodontic Tx completion .

It is designed to :It is designed to : Retain teeth in desired position .Retain teeth in desired position . Allows alveolus rebuilding around Allows alveolus rebuilding around

the teeth before retainer is giventhe teeth before retainer is given .. Massage the gingiva .Massage the gingiva .

2.2. HAWELY RETAINERHAWELY RETAINER It is constructed of clear ,self-It is constructed of clear ,self-

polymerizing acrylic to hold wire polymerizing acrylic to hold wire clasps on molar teeth .clasps on molar teeth .

In maxilla it covers the palate ,while In maxilla it covers the palate ,while in the mandible it covers the in the mandible it covers the anterior floor of the mouth .anterior floor of the mouth .

It passively hold the teeth after It passively hold the teeth after fixed appliance removal ,also it fixed appliance removal ,also it allows some tooth movement to allows some tooth movement to close band spaces & control incisors close band spaces & control incisors ..

3.3. LINGUAL LINGUAL RETAINERRETAINER

It is a cuspid to cuspid fixed It is a cuspid to cuspid fixed retainer which is fabricated retainer which is fabricated from light stainless steal wire from light stainless steal wire & bent to rest against the & bent to rest against the lingual surface of the teeth to lingual surface of the teeth to maintain incisor position maintain incisor position during late growth .during late growth .

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