Orthodontics 538

Monica Schneider, DDS, MS

Clinical Component
6 clinic points are required for completion of the clinic portion of the course - Ortho Assist (2) You must attend 2 postgraduate ortho clinic sessions. Sign-up is necessary; you Signwill have to check in the post-grad ortho clinic on the 3rd floor at 8:50am for the postmorning session and 12:50pm for the afternoon session with Mrs. Amy Revty (Head orthodontic assistant) so she can assign you to one of the residents. We will take a maximum of 5 students on each clinic session. Assist and get as much as you can from the experience. You will get 1 point for assist, so be sure to get swiped into Axium. Axium. - Consults (4) Ortho instructors or postgrads will be available for consults each clinic period. Get as many consults as possible for any ortho question you might have relevant to the patient, child or adult. Each consult =1 point. The consults are done in the orthodontic clinic 3rd floor, if you have a patient for a consult talk to one of the assistants so you can get a chair assigned.

Ortho Competency
- Ortho Competency Students are required to perform a supervised orthodontic examination (following the orthodontic blue form which is in the orthodontic clinic) to an instructor. This is a good opportunity to learn one on one with your instructor. No points are given, this is a requirement.

Bonus Points  

Orthodontic Clinical Credits: One of the requirements to pass this course is that the student must accumulate in the clinic at least six orthodontic clinical credits by the end of the academic year (orthodontic assists and consults) If the student has more than 6 orthodontic clinical credits, he (she) may earn bonus point(s) as follows: 7-8 orthodontic clinical credits: 9 or more orthodontic clinical credits 1 bonus point 2 bonus points 



Typical steps in treatment      Level and derotate the arches Intrude upper and lower anterior teeth Correct AP relationship Close spaces if needed Finish and retention .

Level and derotate the arches  Type of appliance  Standard edgewise vs. Left quadrant  Preadjusted appliance Left quadrant Bracket slots have NO angulation or inclination Bracket slots have angulation or inclination upper lower Ligating wings Bracket slot Bracket base .

e.Level and derotate the arches  Type of appliance  Standard edgewise vs. Left quadrant  Preadjusted appliance Left quadrant Bracket slots have NO angulation or inclination Bracket slots have angulation or inclination upper lower Ligating wings Bracket base and mesh for bonding Bracket slot Base of the slot Bracket base and mesh for bonding The standard brackets the height (profile) of the brackets is the same from the base of the bracket to the base of the slot . compare the diagrams for upper centrals and laterals in both prescriptions) . in the preadjusted appliance the height varies to compensate different tooth thicknesses (i.

Commonly used systems The chart shows a wide variety of systems with the preadjusted appliance notice the variation in torque and angulation comparing different teeth and different prescriptions .

028 inserted into the bracket in the narrowest position .022 slot measurement .Edgewise appliance   The edge wise appliance allows movement of teeth in three planes of space with a single archwire [bc slot is rectangular] Meaning of edgewise  Edgewise slot received a rectangular wire .022x.

Slot sizes      . to insert and bend Can use bigger size wire but does not have to be a very stiff wire .makes them easier (NiTi.018 . A smaller size wire was used to fill up the slot (easier to bend) Today practitioners use:   .018 slot became more common. TMA) .022 50% 50%  Slot size is less important today   Memory wires and more flexible wires (NiTi.022 slot or .018 slot In the past because gold wire was used the slot had to be larger Stainless steel wires were used later and were not as flexible and the .

Design of Brackets  Shape of the Bracket  Single  One set of ligating wings  Twin  Two sets of ligating wings .

Type of Bracket  Standard Edgewise 0 torque  0 angulation   Preadjusted Appliance (Straightwire) (Straightwire)  Changes in torque and angulation Brackets are marked on the distal gingival corner different Colors for each quadrant (some companies have different color for each tooth) .

Larry Andrews     Graduated Ohio State 1958. . Using this sample he formulated the SIX KEYS TO OCCLUSION that these normals supposedly contained. 1960-64 collected 120 non-orthodontic 1960nonnormals. He later found that these six keys were often missing in ABO board cases. normals.

Andrews The distal marginal ridge of the maxillary first molar contacts the mesial marginal ridge of the mandibular second molar. Lawrence F.   Crown Angulation (Tip) Crown Inclination (Torque)    Rotations Spaces Curve of Spee .Six Keys of Occlusion  Molar relationship  Dr.

Preadjusted Appliance (Straightwire)  Crown Angulation (Tip)   The mesiodistal orientation of the clinical crown of the tooth The gingival portion of the long axes of all crowns is more distal than the incisal portion distal mesial .

Preadjusted Appliance (Straightwire)  Inclination (Torque)   The buccolingual orientation of the clinical crown of the tooth Centrals and laterals   All crowns labially inclined The incisal portion of the maxillary incisors is labial to the gingival portion .

Preadjusted Appliance (Straightwire) (Straightwire)  Inclination (Torque)  Upper canines through molars All crowns lingually inclined  The gingival portion is more labial than the occlusal portion of the crown.  .

Preadjusted Appliance (Straightwire)  Inclination (Torque)  Lower incisors  Upright .

Preadjusted Appliance (Straightwire)  Inclination (Torque)  Lower canines through molars  All crowns are lingually inclined .

Preadjusted Appliance (Straightwire)  In.Out In Takes into account the differing faciolingual thicknesses of the upper and lower teeth Preadjusted bracket has increased thickness in the premolar area Standard bracket the same Thickness in all brackets .

Preadjusted Appliance (Straightwire)  Rotation   Eliminates the necessity of putting bends mesial to the first molars buildbuild-in offset Off set bends need to be placed to compensate the rotation of molar and size of second premolar Off sets are build in the brackets and tubes .

Other Designs  Self ligating brackets Disengagement Instrument for smart clip Clip system holds the wire in the slot Smart Clip Bracket Doors hold the wire in the slot Insertion Instrument for smart clip Damon 3 Bracket .

Other Designs  Lingual brackets .

Bracket Materials 

Stainless steel Plastic/acrylic Gold Ceramic Monocrystalline sapphire


Series of aligners used Polysiloxane impression Three dimensional imaging Scanning Sterolitography (models made and trays made from a series of models)

Archwire selection 

The pressure of the wire in the bracket slot generates the force that moves the teeth in all three dimensions

Basic Properties of Elastic Materials  

Elastic behavior determined by stress-strain stressresponse Internal state

Internal distribution of a load  Force applied to a mechanical structure  Equal and opposite to the applied load over unit area 

Stress = Force Area

Strain   Change in dimension of a material due to a external force or load Measured by a change in length Strain = e/ L e = change in length L = original length .

Strain .L. ult.Stress strain curve  Measures the load and deformation and calculates the corresponding strain and stress Elastic Range Plastic Range Stress E.

Characteristics of Importance in Orthodontic wires  Stiffness Resistance to deformation  Opposite to springiness   Strength  Maximum possible load How far the wire can be deflected without being deformed  Working range  .

Characteristics of Importance in Orthodontic wires     Formability Biocompatibility and environmental stability Joinability want to be able to solder Friction .

Load deflection rate    External measurements Force produced by unit of activation Is the force magnitude delivered by an appliance and is proportional to the modulus of elasticity (E) .

Deflection .Mechanical properties of metals  Load deflection curve Elastic Range Plastic Range Load P max P ult.

Proportional Limit    Maximum stress at which stress is proportional to strain Elastic region : before proportional limit Plastic region : after proportional limit .

1% is measured There is a rapid increase in strain w/o a corresponding increase in stress The stress at which a material begins to function in a plastic manner .Yield point    Point at which deformation of 0.

StressStress-strain curve Load Deflection The curve measures load /mm of deflection the stiffer the wire the less deflection = steeper curve .

Resilience and Toughness  Resilience: Resilience:  Maximun amount of energy a material can absorb without undergoing permanent deformation Ability to absorb energy without fracture  Toughness:  .

Resilience and Toughness .

Characteristics of Importance in Orthodontic wires  Stiffness  Resistance to deformation Maximum possible load How far the wire can be deformed  Strength   Working range  .

Wire cross section .

Wire cross section  Round wire  Range Range : d D 2d = 1/2 .

Wire cross section  Round wire  Strength Strength : cubic function of the ratio d D 2d = 8 .

Wire cross section  Round wire  Stiffness Stiffness : d D 2d = 16 .

Wire cross section Strength Springiness Range d D 2d d D 2d d D 2d 8 1/16 1/2 .

Length of the Wire .

Length of the Wire  Range is proportional to the square of the length A B Beam B = 4 Beam A .

Length of the Wire  Stiffness is inversely proportional to the cube of the length Stiffness A = 1 Stiffness B = 1/8 .

Length of the Wire  Strength is inversely proportional to the length A B Strength A = 4 Strength B = 2 .

Length of the Wire Strength Springiness Range LD ½ L D 1 L D 1 2L D 1/4 2L D 8 2L D 4 .

Optimal cross section  Circular cross section Multidirectional activations  Has to be properly oriented  May rotate in the bracket  .

Optimal cross section  Flat cross section Unidirectional activations  Can deliver lower load-deflection rates without loadpermanent deformation  Can be anchored into a tube or a bracket  .

Archwire Material  Stainless Steel Entered dentistry in 1919  Softened by annealing  Some bands  Ligature wires   Hardened by cold working Super grades steels more brittle  Regular grade can be bent without breaking  .

Archwire Material  Stainless Steel Joinability is possible (soldering)  Fused together by welding  Corrosion resistance  Lower friction  .

.018)  Square (.025.022.Archwire Material  Stainless Steel  Sizes Round (. .016)  Rectangular (.021 x . . .016.017 x .018 x . .016 x .016 x .025)  .014.025.

Archwire Material  Stainless Steel  Multistranded wires Specific number of thin wire sections coiled around each other  Round or rectangular cross section  Stiffness of a triple stranded 0.0175 similar to a 0.010 stainless steel wire  .010 stainless steel single stranded  Multistranded 25% stronger than the 0.

Azuraloy  Supplied in a softer state  Hardened by heat treatment  After heat treatment becomes equivalent to regular stainless steel  Good formability  Larger frictional forces  . Elgiloy.Archwire Material  Cobalt chromium wires Elgiloy.

Archwire Material  Beta Titanium (TMA) Introduced in the early 1980s  Commercially available as TMA   Titanium molybdenum alloy Strength and springiness  Simplify appliance design  Good formability  Attach hooks by welding  Higher levels of friction than Stainless steel  .

Archwire Material  Nickel Titanium Alloy      Nitinol Superelastic NiTi Ni-Ti. NitinolCannot be soldered or welded Cannot be easily formed or bent Forces are maintained over a large range of deflection Large deflection . low force wires with memory . Nitinol-SE NiNiTi. Cu NiTi.

Characteristics of a Force 3 1 Point of application Line of action 2 Sense Magnitude 4 .

bone.Center of Resistance  Definition: Point on which object/tooth is perfectly balanced  Depends on characteristics of individual teeth  Elements surrounding teeth  PDL. CT. etc  Center of Resistance .

Center of Rotation  Definition  The point about which a body rotates .

Center of Rotation TYPE OF MOVEMENT Translation Uncontrolled tipping Controlled tipping Root movement CENTER OF ROTATION Infinity Slightly apical to the center of resistance Apex Incisal (occlusal) edge .

Moment  Definition  Magnitude of the force multiplied by the perpendicular distance of the line of action of the force to the center of resistance 20 mm M=Fxd 50 gm .

Couple    Two forces of equal magnitude Parallel noncolinear lines of action Opposite senses 20 mm 20 mm .

Determining the Equivalent Force System Determine the force system at the bracket Determine the equivalent force system at the Cres Distance from the bracket to Cr = 9.8 mm .

Determining the Equivalent Force System .

016 NiTi .016 x . 5.018 x . 2. 6.0175 respond Multistranded SS or .022 slot 1.017 x .016 x .025 SS or higher .014 NiTi .022 NiTi or TMA .025 SS . 4.Wire Sequence  . 3. 7. .022 SS .

Steps in Treatment  Align and level the arches .

Steps in Treatment  Align and level the arches .

Steps in Treatment   Correct vertical relationship Intrude anterior teeth Intrusion arches  Reverse curve wires  .

Steps in Treatment   Correct vertical relationship Intrude anterior teeth Sequence of wires  Step up or down (making bends)  Reverse curve wires  Intrusion arches  .

Steps in Treatment   Correct Anteroposterior relationship Class II Distalize the upper molars  Moving lower teeth anteriorly  Upper molar distalized with pendulum appliance Note space opened Molar Class I .

Steps in Treatment   Correct Anteroposterior relationship Class II Distalize the upper molars  Moving lower teeth anteriorly  .

Steps in Treatment   Correct Anteroposterior relationship Class II  Extraoral Traction  External force to maxillary dentition Attach to strap Insert in upper molar tubes Facebow .

Point of origin of the Force     Depends upon the assembly used Cervical neck Occipital Back of head Parietal Upper part of the head Direction of the distalization force .

Point of Attachment of the Force   Hook of the outer bow Location:  AP axis  V axis .

Headgear Classification Cervical Headgear Combination Headgear Straight pull High Pull Headgear .

Intraoral Elastics  Intramaxillary   Intermaxillary  Class I  Class II elastics     Same arch Upper and lower arches Use with heavy archwires Use as much as possible Evaluate side effects .

Intraoral Elastics  Intermaxillary  Class III elastics .

Intraoral Elastics  Intermaxillary  Vertical Elastics To get better interdigitation  Close the bite if is a mild open bite  .

Intraoral Elastics  Intermaxillary  Cross elastics  Can be used to correct midline deviations .

Coil Springs   Open coils (open space) Closed coils (close space or maintain space) Opening space for an impacted tooth With an open coil Holding the space that was opened while The tooth comes down to the arch .

Steps in Treatment  Close spaces Closing loops  Elastomeric chains  To activate the loop is pulled apart and the wire is bent distal to the molar (cinched back) to prevent the wire from sliding forward and to maintain the force needed for space closure .

Elastomeric Chains .

Steps in Treatment  Finish and retention Finishing wires usually heavy SS or TMA  Choose retainer  Standard Hawley  Essix retainer  .

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