Fixed appliances 2.

Theory of multiband technique

2020
 A short history of orthodontics
Edward H. Angle designed several devices, the
most important of which are:

http://www.anglemidwest.org/about-us.html

• Expansion Arch – 1899

 First commonly used expansive device

 He anchored it with a clamping ring on the first molars
 The teeth were fixed to the arch by wire ligature  it
was disadvantageous for the periodontal tissues
 He used great forces
 It’s made from gold (it was expensive)

https://image.slidesharecdn.com/copyofdeve
lopmentofcontemporaryfixedappliance-
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of-contemporary-fixed-appliance-certified-
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 A short history of orthodontics

• Pin and Tube Appliance – 1913

 The appliance consists gold and platinum rings. These rings were
bonded to the teeth (on every teeth).
 The rings have soldered vertical
tubes  the pins go through
these tubes
 It was able to move the teeth
bodily
 Disadvatage: the activation
required very good manual skill
and a long time, because every
time the tubes and pins had to
be repositioned.
https://image.slidesharecdn.com/bracketsvarun12-140211022325-
phpapp02/95/brackets-in-orthodontics-certified-fixed-orthodontic-
courses-by-indian-dental-academy-18-638.jpg?cb=1505548275
 A short history of orthodontics
• Ribbon Arch Appliance –
1915

 Modified, simplified
version of the Pin and Tube
Appliance
 The rings were already
soldered with brackets,
which had a vertical slot
 Rotational movements can
be performed
https://image.slidesharecdn.com/orthodonticbrackets-140403063024-
phpapp02/95/orthodontic-bracketscertified-fixed-orthodontic-
courses-by-indian-dental-academy-25-638.jpg?cb=1507027478
 A short history of orthodontics
• Edgewise Appliance – 1928

 Angle’s last and the best

appliance
 It was the basis of today's
orthodontics
 The term edgewise refers to the
rectangular wires used in the
treatment, which make it possible
to carry out first, second and third
order bends, adjusting the ideal
curve shape and the correct axis
position for each tooth.
 Wide brackets application
https://www.slideshare.net/indiandentalacademy/edge-wise
A short history of orthodontics

Angle's successores and followers improved

their devices.
 Standard Edgewise Technique
• Tweed and Merrifield

 They modified Angle’s appliance and created the Standard Edgewise

Technique
 The design of the appliance is based on the increase in aesthetic
requirements, health and functional stability
 This technique is suitable for performing extraction cases
 Application of sliding mechanics
 Bodily tooth movements
 Application of stainless steel wires
 Use brackets with horizontal slot, which size is 0,022 x 0,028”
 Metal ligature was used to fix the wire in the brackets

https://image.slidesharecdn.com/historyfixed
appliances-160325134902/95/history-fixed-
appliances-9-638.jpg?cb=1458913781
 Bending to determine the position of
the teeth
First order bends:
Vestibulooral position of the tooth (in-out)

• Placement of crowns in a horizontal plane

• Rotation settings of crowns
 Bending to determine the position of
the teeth
• Elements of the first order bend in the upper arch’s wire:

 Incisor curvature
 Lateral incisor inset
 Canine offset
 Canine curvature
 First molar offset
 First molar curvature
 Second molar offest and curvature
https://www.google.com/search?q=first+order+bend&s
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 Bending to determine the position of
the teeth
• Elements of the first order
bend in the lower arch’s wire:

 Canine curvature
 First premolar offset
 First premolar curvature
 First molar offset
 First molar curvature
 Second molar curvature and
offset
https://image.slidesharecdn.com/finishingfinal2-
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 Bending to determine the position of
the teeth
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• Influence of mesiodistal axis

position of teeth (angulation)
• These bends are also known
as artistic bends
• The bracket slot is always
perpendicular to the crown
axis
• Angulation bends should be
integrated into the wire
https://image.slidesharecdn.com/finishingfinal2-160510060202/95/finishing-
and-detailing-in-straight-wire-technique-fixed-orthodontics-courses-19-
638.jpg?cb=1506340629
 Bending to determine the position of
the teeth
Third order bends:

• Elements of the third order

bend is the torque
(vestibulooral inclination)
• It can only be bent into a
rectangular wire
• You can bend it by twisting the
rectangular wire
• The torque effect on the teeth
results from a defined
interaction between the
bracket slot and the wire
Bending to determine the position of
the teeth

Totally 76 bends are required in standard

edgewise technique.
 Six keys to normal occlusion
It was written by Lawrence F. Andrews – 1972

1. Molar interarch relationship

• The mesiobuccal cusp of the upper first molar occludes in

the fissure between the mesiobuccal and the centrobuccal
cusp of the lower first molar.
• The distal surface of the disto-buccal cups of the upper first
molar occludes with the mesial surface of the mesio-buccal
cups of the lower second molar.
• The upper canine occludes between the lower canine and
the lower first premolar.

https://www.checkdent.com/profiles/lawrence-andrews-92107-2798-
sandiego-24528.html
 Six keys to normal occlusion
1. Molar interarch relationship

https://image.slidesharecdn.com/andrews6keys-130215073044-phpapp02/95/andrews-six-keys-of-occlusion-2-638.jpg?cb=1360913514
 Six keys to normal occlusion
2. Mesiodistal crown angulation
• The incisal end of the longitudinal axis of the
crowns is always more mesial than the
gingival, but the extents of the angulations are
different in every tooth types.

https://www.slideshare.net/proffouda1/six-keys-of-normal-occlusion-dr-maher-fouda
 Six keys to normal occlusion
3. Vestibulooral inclination
of the crown (torque)
• This is a positive value for
the upper incisors  the
upper incisors incline https://encrypted-
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labially.
• The lateral teeth and the
canines incline
palatally/lingually 
negative torque value.
https://www.slideshare.net/proffouda1/six-keys-of-normal-
occlusion-dr-maher-fouda
 Six keys to normal occlusion
4. No rotations

https://www.slideshare.net/proffouda1/six-keys-of-normal-occlusion-dr-maher-fouda
 Six keys to normal occlusion
5. Tight proximal contacts
No spaces.
 Six keys to normal occlusion
6. Flat curve of Spee

https://image.slidesharecdn.com/sixkeysofnomalocclusion-171112140710/95/six-keys-of-normal-occlusion-dr-
maher-fouda-16-638.jpg?cb=1510496922
 Straight Wire Technique
• Andrews used his theory to design new types of brackets.
These correspond to the brackets we use today.
• Brackets are individualized for each tooth type, meaning
that tooth-specific axis position information, angulation,
and torque values ​are already built into the bracket.
• These brackets are called "triple control" brackets.
• To use triple control brackets and rectangular wire, enabled
the spread of the Straight Wire technique.
• The advantage of the straight-wire technique is that the
values are served the accurate tooth alignment, built into
the brackets.
• These values ​vary from technique to technique.
 Straight Wire Technique
First order bend:

• The elements of first order

bends can be reached, if the
bracket’s base is made thicker
or thinner.
• At that tooth where we make
inset in the standard wire, the
bracket base is thicker, and
where we make offset in the
wire, the bracket base is
thinner.
Rehák-Riskó:Hasund orthodoncia
 Straight Wire Technique
Second order bend:

• The slot line is at an angle with

the straight line, which is
perpendicular to the bracket
wings, what is the required
angulation of the tooth.
• The brackets should be
bonded in that way where the
direction of the bracket wings
coincides with the vertical axis
of the crown.
https://www.magonlinelibrary.com/doi/abs/10.1296
8/ortu.2010.3.3.76?journalCode=ortu
 Straight Wire Technique
Third order bend:

• The vestibulooral tooth tip is achieved by

tilting the bracket up or down

https://luishuanca.ch/en/insignia-forsus-torquecompensation/
 Straight Wire Technique
• The torque value can be
built:
Into the bracket’s slot
(torque in face)
Into the bracket’s base
(torque in base)

https://www.slideshare.net/indiandentalacade
my/brackets-61933854
 Straight Wire Technique
• The torque value what is built
into the bracket would be fully
effective if the orthodontic wire
filled the bracket slot
completely. https://www.ajodo.org/article/S0889-
5406(12)00901-8/pdf
• This practically never happens
because there is always a
"playing field" between the slot
and the wire.
• The thicker the wire, the smaller
the playing field.
https://www.slideshare.net/indiandentalacademy/torqu
e-31925936
 Terminology
The term multiband is used, but instead the
term multibracket or multibond or direct
bonding is more expressive, as the bands were
replaced by direct fixing of the base of the
bracket with adhesive.

https://dobienews.scuc.txed.net/22221/student-life/braces-at-dobie/
Comparison of standard bracket and
triple control bracket

https://www.researchgate.net/figure/Top-line-Scanning-electron-microscopy-of-one-bracket-of-standard-edgewise-appliance-
from_fig1_221927829
Thank you for your attention!