SYLHET CENTRAL DENTRAL COLLEGE

ORTHODONTICS
DR. Moniruzzaman monir
Fixed orthodontic appliances

Fixed orthodontic appliances are devices, which are fixed or attached on to the tooth surface, and forces
are exerted via these attachments using arch wires and / or other auxiliaries.

Fixed Appliances are devices or equipments that are fixed to the teeth either by cementation or bonding
to the etched teeth surface , cannot be removed by the patient and are capable of causing various tooth
movement.

Advantages of fixed appliances:

a. Fixed appliances can bring about various types tooth movements including bodily movement,
rotation, tipping, intrusion, extrusion & root movement.

b. Fixed appliances therefore very versatile & can be used to most malocclusions.

c. Multiple tooth movements are possible simultaneously.

d. More precise tooth movements & detailing of occlusion is possible using fixed appliances.

e. Fixed appliances offer better control over arch

9 Disadvantages of fixed appliances:

a. The most important disadvantage is oral hygiene maintenance which becomes more difficult. Plaque
& food debris tend to accumulate around the attachments & cleaning of the teeth becomes more
difficult for the patient.

b. Fixed orthodontic appliances require special training of the operator & invariably handle by
specialized orthodontist. Otherwise there is greater possibility of producing adverse tooth movements.

c. Damaged appliances that apply miss – directed forces cannot be removed by patient.

d. Fixed appliances are by far more expensive than removable appliances.

indication

Fixed Appliances are indicated when precise tooth movements are required

 Correction of mild to moderate skeletal discrepancies

 Correction of rotation

 Overbite reduction by intrusion of incisors

 Multiple tooth movements required in one arch

 Active closure of spaces: extraction spaces/hypodontia

Component of fixed appliances:

A. Active components:

Arch wire

Spring

Elastic

Separator

B.Passive components:

Band

Bracket

Buccal tube

Lingual attachments

Lock pin

Ligature wire

Active components: Parts which give force.

Passive component: Parts do not give force but remain.

Separator

 Orthodontic separators commonly known as spacers

 They are made up from rubber bands or metal.

.Spacers are placed between the molars at the second orthodontic appointment, before molar bands
are applied
.
Purpose

 Spacers are usually used to create spaces in between teeth before placement of braces.

 They are usually rubber, but sometimes they can be metal.

 Sometimes very painful, they are usually in place for 1 to 2 weeks.

 Spacers can also cause toothache and gum pain because of the constant pressure against the teeth.

How to apply the separator ?

 Special orthodontic tools are used to stretch or open the rubber bands, depending on crowding.

 If the jaw is crowded, the spacers may cause intense and constant pain due to the tooth movement

Ring separators

• These are small elastic rings that are stretched and passed through the interdental

contacts using the separator placing pliers or using two pieces of dental floss .
The elastic material used to make these ring separators can be either round or

with edges. Round ring separators are the most comfortable for the patient as

they fit snugly in the interdental region. Separation takes about 7 days

Dumb-bell separators

• These consists of a dumb-bell shaped piece of elastic that is stretched and

passed through the contacts between adjacent teeth .

• The elastic of the separator constricts over time to regain its original space

and causes separation.

B. Arch wires

• Arch wires are available in the prefabricated mould with variable dimensions and materials .

• They may be of various shapes depending upon the arch form type .

• The arch form closest to the patient should be chosen unless some change is planned in the arch
width
Classification of arch wire

Based on material used:

1. Gold and Gold alloys

2. Stainless steel

3. Nickel Titanium alloys

4. Beta titanium

5. Cobalt chromium nickel alloys

6. Opt flex arch wire

Based on cross section:

A. Round

B. Square

C. Rectangle

D. Twisted

E. Coaxial
Elastics

Elastics are available in various strengths, which is dependent upon their diameter and

thickness. The elastics are chosen according to the purpose of their use. They may be color

coded according to strength.

Elastics can be of latex or non-latex material. Non-latex elastics deteriorate

less as compared to the latex elastics in the oral environment

Class I elastics

These are intra-arch elastics placed mainly between the molars and the

anteriors in the same arch .

Class II elastics

• These are intermaxillary elastics placed between the mandibular molars

and maxillary anterior.

• These elastics may be used to produce intrusion of maxillary anterior

(Begg therapy stage I) or decrease the over jet by retracting the maxillary

anterior.

Class III elastics

• These are again intermaxillary elastics placed between the maxillary molars and
mandibular anteriors .

• These are generally used in the treatment of Angles Class III malocclusions to

bring about the retraction of mandibular anteriors and protraction of the maxillary

molars.

Cross bite elastics: These intermaxillary elastics are used to correct cross bites in the buccal segments.
Their placement is dependent upon the tooth in cross bite, generally from the palatal surface of the
maxillary molars orb premolars to the buccal of mandibular molars or premolars. Small dimension
elastics are used for this purpose.

E. Springs

Various types of springs are used as auxiliaries to generate tooth moving forces. Springs are mainly used
for tooth uprighting and torquing in the Begg’s appliance therapy and the tip edge appliance.

Open coil springs

The spring of appropriate length is compressed between two or more teeth to open

up the space between its points of attachment

Closed coil springs

Closed coil springs can be made of stainless steel or nickel titanium alloys. They are used to

close spaces. Once the spring is stretched and attached at two ends, it tries to achieve its

prefabricated length by closing the gap between its points of attachment .

Uprighting springs

• Generally made of 0.012” or 0.014” Australian wire. They move the tooth root

in a mesial or distal direction .

• The standard designed spring can be used with the Begg and the Tip-edge

brackets whereas, the side-winder design was especially made for use with

the Tip-edge bracket.

Torquing springs

• Torquing springs are usually made of 0.012” or 0.014” Australian wire. They are capable of

moving the tooth roots in a labial or lingual/palatal direction.

• Force is generated when the spring is deformed and engaged along the archwire. Force is

transmitted to the tooth crown by the spurs, which contact the teeth.

PASSIVE COMPONENTS OF FIXED APPLIANCE

1) Bands:

 It helps in fixing the various attachments on to the teeth.

 The are made of from soft stainless steel.

 The attachments like molar tube and brackets are

soldered or welded on to the band and band will be

cemented around the teeth.

 Prefabricated band are also available. The use of these

bands reduces the chair side time by eliminating tedious

procedure like pinching.

2) Brackets

 Brackets acts as handles to transmit the force from the active

component to the teeth.

 Brackets have one or more slots that accept the arch wire.
2) Molar tube / Buccal tube:

 Buccal tube can be weldable on to the bands or they can

be bondable directly to the teeth.

 Buccal tube can be round or rectangular.

 The buccal tube sometimes have double or triple tubes.

These additional tubes for additional wires.

2) Accessories:

1) Lock pins

 It is small pins that are used to secure the arch wire into

the bracket with vertical slot such as ribbon arch

brackets.

 It is usually made of brass

2) Ligature wire

 They are soft stainless steel wire of 0.009 to 0.011 inches

in diameter and are used to secure the arch wire to the

bracket and it is known as ligation

 Ligation is necessary in edgewise type of brackets

because it have labially facing slot

 Elastic ligature can also used to secure wire into the

brackets

2) Brackets

 Brackets acts as handles to transmit the force from the active

component to the teeth.

 Brackets have one or more slots that accept the arch wire.

Types of brackets:
 1. Edgewise brackets:

2. Ribbon arch brackets:

3. Weldable and bondable brackets:

4. Metallic brackets:

5. Ceramic brackets:

6. Plastic brackets

2) Accessories:

1) Lock pins

 It is small pins that are used to secure the arch wire into the bracket with vertical slot such as
ribbon arch brackets.

 It is usually made of brass

2) Ligature wire

 They are soft stainless steel wire of 0.009 to 0.011 inches

 in diameter and are used to secure the arch wire to the

bracket and it is known as ligation

 Ligation is necessary in edgewise type of brackets

because it have labially facing slot

BANDS FOR ATTACHMENTS. BONDED ATTACHMENTS.

1. SEPERATION

2. FITTING BANDS

3. CEMENTATION

Disadvantages:

1. Less esthetic.

2. More caries and gingival plaque.

3. Discomfort to the patient.

4. Cannot use in partially erupted

tooth.

5. Require separation.

6. Detachment is difficult.

7. Space remain after treatment.

 Mechanical locking of an adhesive

to irregularities in the enamel

surface of the tooth and to

mechanical locks formed in base of

the 0rthodontic attachment.

 COMPONENTS OF THE SYSTEM :

1. Tooth surface and its preparation.

2. The design of the attachment

base. 3. Bonding material itself.

 By two main methods:

1. Direct Bonding

2. Indirect Bonding

BONDED ATTACHMENTS

Direct Bonding

 1. Cleaning

 2.Acid etching

 3.A small amount of bonding

agent is squeezed into the mesh

on the back of the bracket , and it

is pressed to place on the tooth

surface.

 4.Excess bonded material is

removed from around the bracket

 5.For light cured materials, a

cordless light is used to activate

the adhesive bonding process

 6.The bracket is bonded in place

BONDED ATTACHMENTS

 Indirect Bonding

 1.Brackets are placed precisely on a cast of

the teeth and held in place with a fitted resin

 2.After the brackets are cured in the ideal

position, a transfer tray is formed and placed

on the working cast.

 3 The trays are removed from the working

cast after soaking in warm water and

trimmed.

 4. The teeth are isolated , etched, and a

chemically cured to a resin that is painted

on the etched enamel and brackets.

 5. After the resin has completely set , the

trays are carefully removed , leaving the

brackets bonded to the teeth.

FIXED APPLIANCE TECHNIQUES

1. Edgewise appliance

2. Begg appliance or light force

technique or differential technique

3. Preadjusted Edgewise Appliance or

Straight Wire appliance

4. Tip Edge technique

STAGES IN FIXED APPLIANCE THERAPY

Leveling and alignment of teeth

Working stage
 Overjet correction

Overbite control

Finishing

Retention

Leveling and alignment

Alignment of arch

Correction of crowding

Crossbite correction

Exposure and alignment approach for impacted teeth

Diastema closure

Leveling by extrusion and intrusion

Working stage

Correction of molar relationship using inter-arch elastics

Overbite control

Overjet correction

Decreasing curve of spee

Open bite correction

Closure of extraction spaces

Maintenance of suitable arch form

Finishing stage

Alignment of individual teeth positions

Root paralleling

Torque of incisors

Correction of midline discrepancies

Final settling of teeth

Debanding and debonding

Instructions for patients wearing a fixed appliance:

a. Clean the teeth with a brush immediate after every meal & before go to bed. If teeth
are not kept clean, damage will occur.

b. Avoid eating hard & sticky food.

c. Since it will be necessary to use a tooth brush after eating, most patients find it best to
avoid snacks between main meals.

d. Contact the orthodontist if the appliance hurts, become loose or any part however
small is broken.

e. Continue the routine dental visits.