Fixed appliances

components, advantages and disadvantages of fixed orthodontic appliances

1. بسم الله الرحمن الرحيم Ibn Sina University Faculty of Dentistry Department of Orthodontics Fixed appliances Mohanad Elsherif BDS (U of K), MFD RCSI, MFDS RCPS( Glasg ), MSc (Orthodontics), M.Orth . RCSEd

2. Definition A group of orthodontic appliances that are fixed to the teeth and cannot be removed by the patient .

3. Advantages They are fixed thus less patient cooperation is needed. More accurate results because precise tooth movement can be done. All types of tooth movement can be done. Multiple types of tooth movement can be done at the same time .

4. Disadvantages Require more oral hygiene measures by the patient. Need specialist orthodontist. High and precise anchorage control. Long chairside time. Poor aesthetics compared to removable appliances. High cost.

5. Absolute indications tooth movements are required. Correction of mild to moderate skeletal discrepancies. Active intrusion/ Extrusion of teeth. Correction of sever rotation. Overbite reduction by intrusion of incisors. Multiple tooth movements required in one arch. Active closure of spaces: extraction spaces/hypodontia.

6. Components 1. Brackets. 2. Bands or buccal tubes. 3. Archwires . 4. Auxiliaries

7. 1. Brackets The force required for orthodontic tooth movement is transmitted from the active components to the teeth through the brackets. Conventional brackets consist of base , slots and wings .

8. Types of brackets A. according to material Metal brackets (stainless steel, Titanum , gold) Ceramic brackets Plastic brackets

9. Clear brackets Plastic brackets Ceramic brackets Good aesthetic initially but get staining and discoloration with time Aesthetic, Durable and resist staining Poor dimensional stability Dimensionally stable Hight friction Hight friction Bulker than metal bracket Can cause wearing of teeth. Brittle thus it is liable to fracture Can result in enamel damage during deboning Green = advantage

10. Types of brackets B. According to bonding mechanism A. Weldable brackets. B. Bondable brackets.

11. Types of brackets C. According to bracket slot: 1. Slot direction: Horizontal slot e.g. Edgewise brackets Vertical slot e.g. Begg bracket 2. Slot size: 0.018”x0.025” inch 0.022”x0.025” inch

12. Types of brackets D. According to ligation of bracket: Conventional ligation brackets. Self-ligating brackets.

13. Types of brackets E. According to bracket system Standard Edgewise brackets. Preadjusted (Straight-wire) edgewise brackets. Begg brackets. Tip-edge brackets.

14. Standard Edgewise brackets Frist order bend (in-out) Second order bend (tip) Third order bend (torque)

15. Preadjusted (Straight-wire) edgewise brackets

16. Begg brackets

17. Tip edge brackets

18. 2. Bands Bands are thin strips of stainless steel which are adapted to the contours of the tooth to which attachments are welded or soldered. TYPES : It can be: a. Preformed b. Custom made OR: 1. molar band 2. premolar band 3. incisors bands

19. Indications for banding Teeth that will receive heavy intermittent forces against the attachments. Teeth that will require both labial and lingual attachments. Teeth with short clinical crowns. Teeth with extensive restorations.

20. 2. Buccal tubes Can be used in posterior teeth instead of bands. They are usually bonded to the teeth just like brackets.

21. Advantages of bonding over banding It is aesthetically superior. It is faster (i.e. less chairside time). It is easier to maintain good oral hygiene. It can be done in teeth with abnormal morphology. The risk of caries under the loose band is eliminated.

22. 3. Archwires These is the main active component used to produce tooth movement in fixed appliances. Comes in verity of shape, size and diameter. The basic three archwire form are square, ovoid and tapered. Tapered Square Ovoid

23. Types of Archwires 1. According to wire material: Stainless steel. Nickel-Titanium. Beta-Titanium. Cobalt chromium. Precious metal. Composite Plastics.

24. Stainless steel wires Steel is an alloy of Iron and Carbon with up to 2% carbon. If chromium of morae than 11% is added the alloy is referred to as stainless steel. Stainless steel used in orthodontic wires is named 18-8 stainless steel according to its chromium (18%) and Nickle (8%) respectively.

25. Nickle - Titanium wires Originally developed for US space program Ni- Ti alloys have two unique properties: 1. Shape memory: The wire gets back to its original shape. 2. Superelasticity : Thus the wire would exert the same force regardless of the amount of deflection.

26. Types of Archwires 2. According to cross-section: A. Round. B. Square. C. Rectangular. Round Square Rectangular

27. Types of Archwires 3. According to diameter of the wire: A. Round: 0.012, 0.014, 0.016, ...etc. B. Square: 0.016 x 0.016, 0.017 x 0.017…etc. C. Rectangular: 0.016 x 0.022, 0.019 x 0.025 …etc.

28. Types of Archwires According to number of the strands Single stranded. Multi-stranded.

29. 4. Auxiliaries 1. Separators. 2. Ligature wires. 3. Elastic modules. 4. Elastic chains. 5. Elastic bands. 6. Springs.

30. 1. Separators Tight proximal contacts does not allow proper banding of teeth. Separators are used to create space for banding teeth. Types: Metal separators Elastic separators

31. 2. Ligature wires (active ties) These are soft stainless steel wires of 0.009-0.011 inches in diameter. Used to secure the arch wire to the brackets.

32. 3. Elastic modules Used to secure the archwire to the bracket. Available in different colors. They are faster to place and replace compared to ligature wires.

33. 4. Elastic (power) chains Made of synthetic polyuraethene material arranged in a long chain of interconnected rings. Available in different colors. It can be light , medium or heavy depending on the distance between the rings.

34. 5. Elastic Bands They are usually made of latex rubber (although latex free elastics are now available). Available is various diameter, thickness and colors.

35. Types of elastics bands 1. Class I elastics: Intra-arch elastics stretched between molars and anteriors . Used for closer of space and retraction of teeth.

36. Types of elastics bands 2. Class II elastics: Intermaxillary elastics, stretched between lower molars and upper anteriors . Used in treatment of class II malocclusion ( retraction of upper anteriors and mesial movement of lower molars.

37. Types of elastics bands 3. Class III elastics: Intermaxillary elastics, stretched between the upper molars ad lower anteriors . Used in treatment of class III malocclusion to bring about mesial movement of upper buccal teeth and retraction of anteriors .

38. Types of elastics bands 4. Crossbite elastics: Used to treat molar crossbite . They are intermaxillary elastics extend between the palatal surface of upper molar and the buccal surface of the lower molar and vice versa.

39. Types of elastics bands 5. Box elastics: Used to correct anterior open bite, the elastic is stretched between the upper and lower anteriors like a box

40. 6. Springs 1. Open coil spring: Compressed between two teeth to open up space between them.

41. Springs 2. Closed coil spring: Stretched between teeth to close space.

42. Springs 3. Rotation spring: Used to correct rotated teeth. 4. Uprighting springs: Move teeth in mesial or distal direction. 5. Torqueing spring: Move teeth in lingual or palatal directions.

43. Distal end cutter

44. Ligature cutter

45. Matheiu forceps

46. Bracket holder

47. Separator forceps

48. Band Pusher

49. Band Seater

50. Bracket Remover

51. Band Remover

52. Esthetic and Ortho!!?

53. Clear Polymer Archwires With ceramic brackets

54. Lingual appliance

55. Clear aligners

56. Declaration The author wish to declare that; these presentations are his original work, all materials and pictures collection, typing and slide design has been done by the author. Most of these materials has been done for undergraduate students, although postgraduate students may find some useful basic and advanced information. The universities title at the front page indicate where the lecture was first presented. The author was working as a lecturer of orthodontics at Ibn Sina University, Sudan International University, and as a Master student in Orthodontics at University of Khartoum. The author declare that all materials and photos in these presentations has been collected from different textbooks, papers and online websites. These pictures are presented here for education and demonstration purposes only. The author are not attempting to plagiarize or reproduced unauthorized material, and the intellectual properties of these photos belong to their original authors.

57. Declaration As the authors reviews several textbooks, papers and other references during preparation of these materials, it was impossible to cite every textbook and journal article, the main textbooks that has been reviewed during preparation of these presentations were: Contemporary Orthodontics 5 th edition; Proffit , William R, Henry W. Fields, and David M. Sarver. Handbook of Orthodontics. 1 st edition; Cobourne , Martyn T, and Andrew T. DiBiase . Clinical cases in orthodontics. Martyn T. Cobourne , Padhraig S. Fleming, Andrew T. DiBiase , Sofia Ahmad Essentials of orthodontics: Diagnosis and Treatment; Robert N. Staley, Neil T. Reske Orthodontics: Current Principles & Techniques 5 th edition; Graber, Lee W, Robert L. Vanarsdall , and Katherine W. L. Vig Orthodontics: The Art and Science. 3rd Edition. Bhalajhi , S.I.

58. Declaration For the purposes of dissemination and sharing of knowledge, these lectures were given to several colleagues and students. It were also uploaded to SlideShare website by the author. Colleagues and students may download, use, and modify these materials as they see fit for non-profit purposes. The author retain the copyright of the original work. The author wish to thank his family, teachers, colleagues and students for their love and support throughout his career. I also wish to express my sincere gratitude to all orthodontic pillars for their tremendous contribution to our specialty. Finally, the author welcome any advices and enquires through his email address: [email protected]

59. Thank You