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FIXED ORTHODONTIC

APPLIANCES
Prepared and Presented By:
Musab A.rahman

DEFINITION:
Are attachments that are fixed to the tooth
surface, the forces are exerted via the
attachments using arch wires and/or other
auxiliaries thus are capable of greater range of
movements than that of the removable ones.
It cannot be adjusted neither removed by the
patients

ADVANTAGES:
Precise tooth control
Is possible because its possible to move the
teeth in 3 planes of space so
achieving
perfect alignment of teeth both inter and intra
arch

Multiple tooth movement are possible:


1.Individual tooth can be moved in 3 planes of
space simultaneously e.g: a tooth can be
intruded and retracted simultaneously
2.Different teeth can be moved at the same
time in different directions e.g one can be
derotated while the other is retracted

Patient cooperation is reduced compared to


that of the removable appliance

DISADVANTAGES
Oral hygiene requirements:
It becomes difficult as the food debris tends to
accumulate around the attachments

Esthetics:
Fixed appliances are generally made out of
metals so not esthetically accepted by most
patients. The advent of lingual technique and
tooth colored brackets have helped to
overcome this advantage so far.

Requires special training for the operator


( although simple cases can be done by a GP)
Expensive

Increases the chair side time:


Since its fixed and cant be removed by the
patient all the modifications and adjustments
should be done by the dentist
So increasing the time

Anchorage control is difficult compared to


that of the removable
Ttt monitoring is difficult as the patient
must be recalled in regular visits for
adjustments/reactivators

Fixed orthodontic appliances are indicated


whenever multiple tooth movement is required:

Correction of mild to moderate skeletal


discrepancies As fixed appliances can be used
to achieve bodily movement it is possible,
within limits, to compensate for skeletal
discrepancies and treat a greater range of
malocclusions.

Intrusion/extrusion of teeth Vertical


movement of individual teeth, or tooth
segments, requires some form of attachment on
the tooth surface onto which the force can act.
Correction of rotations

Overbite reduction by intrusion of incisors


Multiple tooth movements required in one
arch
Active closure of extraction spaces, or
spaces due to hypodontia Fixed appliances can
be used to achieve bodily space closure and
ensure a good contact point between the teeth

CONTRAINDICATIONS
:
Poorly motivated patient:
As the patients responsibility os not limited to
maintaing a good oral hygiene but will also
involve elastic and headgear wearing and
keeping appointments at regular intervals

Poor dental health:


patients with poor dental hygiene are likely to
suffer from periodontal deiseases

Malocclusions beyond the scope of FOA


e.g skeletal
Non specifcialists, only orthodontists are
qualified to impart ttt using FOA

COMPONENTS:
Active
passive

ACTIVE
These include components which are capable
of generating tooth moving forces. These
include:
a. Separators
b. Archwires
c. Elastics
d. Elastomerics
e. Springs

f. Magnets

Seperators are used to create space between


2 adjacent teeth generally to band them
Has several types:

BRASS WIRE
Initial soft brass wire 0.5 to 0.6mm passed
interdentally and twisted
They were painful, caused lacerations due to
the uncontrolled forced

Brass separators in
place medial and
distal to the maxillary
left first molar

Laceration injury
caused because of
loosening of
the twisted end of the
brass separator

KESSLYING
SEPERATOR
are made of 0.016 special plus Australian
wire with helices at the closed end. The open
straight arm passes below the contact
sufficient space is created within 4 hours of
application

The short arm of


the separator is
held in a
Weingart plier

The long, hooked


arm is placed
under the
contact point and
the short arm is
pulled laterally by
the plier

The separator is rotated into position


with the long,
hooked arm of the separator over the
contact point and the
short arm under the contact point

RING SEPERATORS
Are small elastic rings that are stretched and
passed through the interdental contacts using
separators placing plier

Elastic
separators. The
lose ones have
a rectangular
cut section
whereas the
ones on the
stick are round

Placement of elastomeric
separators using dental
floss. Two pieces of floss are
placed through the hole in the
center of the separator and are
held one in each hand

The separatorplacing plier

Snugly fitting elastic


separators

ARCH WIRES
Are available in various dimentions and
materials
Physical properties:
Springback: ability to return to its original
shape after an applied force

Stiffness: amount of force required to bend


or deflect the wire
Formability: ease in which the wire bends
into the desired shape
Resilience: stored energy remaining after
deflection w/o permanent deformity

Biocompatibility
Joint ability: whether the material can be
welded or soldiered
Frictional characteristics

CaCr

TMA

NiTi

ss

Low

Medium

High

Low

Springba
ck

High

Medium

low

High

Stiffness

Good

Good

poor

Good

Formabil
ity

Low

Medium

High

Low

Resilienc
e
SS, stainless steel; NiTi, nickel titanium; TMA, ?
Good
Good
Good
.Biocomp
titanium; CoCr, cobalt chromium.
medium
high
medium
low
Friction
*CoCr

TYPES
Stainless steel
Stainless steel is an alloy consisting of iron, chromium and
nickel, which has a large modulus of elasticity. As such, stainless
steel archwires are generally stiff and resist deformation, which
makes them ideal as working archwires, flexibility of stainless
steel archwires can be increased by winding several smaller
wires together to form large multistrand or twistflex wires; or
wrapping smaller wires around a larger central wire to produce a
coaxial wire

Cobalt chromium
Commercially marketed as Elgiloy, cobalt chromium
has a greater formability than stainless steel and
similar stiffness, but with greater friction. It can be
hardened by heat-treating in the laboratory and is
used for the construction of auxiliaries, such as an
intrusion arch or quadhelix.

Beta titanium
Introduced in the 1980s, beta titanium wires have
good formability, with a stiffness of around one-third
that of stainless steel; but they are also associated
with higher
friction. These archwires are used in the fi nal stages
of treatment, when finishing bends may be required
to detail individual tooth position and achieve
settling of the occlusion.

Nickel titanium
Nickel titanium or NiTi archwires are
characterized by high fl exibility and the delivery of
low force over long range. They also exhibit the
phenomenon of shape memory; when deformed they
will tend to return to their original shape; and
superelasticity, the wire delivering the same force
over a large range of deformation

These wires are ideal for aligning teeth during the


initial stages of treatment. However, the properties
of low stiffness and poor formability make nickel
titanium an unsuitable material for later stages of
treatment where a stiffer archwire is required for
space closure and overbite control.

ELASTICS
Can be made of latex or latex free
Are available inn various strengths which
depends upon the diameter and thickness, are
chosen according to purpose and colour coded
by strength

classI:
Are intra arch mainly placed between the
molars and incisors in the same arch to close
the extraction spaces by retracting anterior
teeth or protracting the posterior

Class I elastics, the horizontally


placed green
elastics seen in the above and
below photographs

classII:
Are intermaxillary placed between mandibular
molars and maxillary anteriors, can be used to
produce intrusion of max. anterior (Begg
therapy stage1) or decrease the overjet by
retraction of the max. anterior

Class II elastics are


placed between the
mandibular molars and
the maxillary anteriors

Class III:
Are intermaxillary placed between maxillary
molars and mandibular incisors, generally in
the TTT of angle class III malocclusions

Class III elastics

Diagonal elastics:
Worn for midline deviation correction

Horizontal pink colored


elastics are Class I elastic

Cross-bite elastics
Are intermaxillary and used to correct cross
bite in the buccal segment and placed
according to the tooth in cross bite, generally
from the palatal surface of the maxillary molars
or premolars to the buccal of the lower molars
or premolars

Cross bite elastics

Box elastics: used to correct the anterior


open bite, they extend between max. and man.
Causing the distal tipping of the maxillary
anterior and/or forced eruption of max. and/or
mand anteriors

Box elastic

Extra-oral elastics: are used in conjuction


with extra-oral appliances like a face mask
It usually exerts high forces (0.8 to 14 oz)

Extra-oral elastics

ELASTOMERS
Are generally made of polyurethane
materials, found in various forms:
Elastic chains ( aka E-chains ):
Used for space closure and are available in 3
different strengths based on the distance
between the rings (continous,closed,long )

Continuous elastic chain

Long elastic chain

Closed or short elastic chain

Elastic thread or cotton thread:


Made from special type of cotton and are used
to correct the de-rotations, consolidation of
anterior space

Figure of 8 placement of the cotton thread

Elastic ligature:
Used to secure the arch wires in edgewise or
pre adjusted edgewise brackets.

Elastic modules or elastic links


Are made of 2 elastic rings seperated by a
variable distance, availabe in different sizes
based on the inter-ring distances, are generally
used to close spaces or de-roation of anterior
teeth

SPRINGS
Various types of springs are used as auxiliaries
to generate tooth moving forces, are mainly
used for tooth up-righting and torqueing in
beggs appliance therapy, tip edge appliances.
Spring maybe used to open spaces ( open coil
spring) or close spaces (closed coil spring)
Has the following types:

Up righting springs:
Made of 0.012 or 0.014 Australian wire,
they move the tooth root in a mesial or distal
direction

Mesiodistal
uprighting
springs

Rotating spring: provides for a simple and


effective means for de-rotating teeth without the
removal of the arch wire, they are capable of
clockwise or anticlockwise motion according to the
design

Rotating
springs

Torquing spring:
Capable of moving the root labial/lingual or palatal
in direction, the force is generated when the spring
is deformed and engaged along the arch wire

Torquing spring used for


buccolingual
root movement

Goodman Torqueing Spring

Open coil spring:


Are either made of SS or NiTi alloys. The force
exerted depends on the diameter of the wire of
which its made of, its used spring of appropriate
length is compressed b/w 2 or more teeth to open up
its points of attachment

Open coil spring in place

Closed coil spring:


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

Closed coil spring stretched from the


molar, premolars to canine bracket
for the retraction of the canine

PASSIVE
Are those components which are not capable of
generating tooth movement forces but help in
providing attachments for other auxillaries to the
tooth or retaining other active components
A-Bands
B-Brackets
C-Buccal tubes

D- lingual attachments (buttons, seating lugs, cleats,


sheaths, ball hook)
E- lock pins
F- ligature wires

BANDS
Are either costume fabricated or commercially
made sizes
Are metal attacments (encircles the tooth) that are
cemented and provides a place for attachments of
other auxillaries which can be either welded or
solidered to the band

Indications:
1-teeth that will receive heavy intermittent forces
against the attachments (primary indication) e.g
upper 1st molar against extraoral forces will be
placed via a head gear

2- teeth that will need both labial and lingual


attachments e.g a molar with both headgear and
lingual arch wires
3- teeth with short clinical crowns

Steps of banding:
-Step I Separation of adjacent teeth:
can be achieved using separators for a duration of 2
to 7 days depending upon the separator used.

-Step II Selection of band material


Thinner band material lesser in width is used for
anterior (0.010 3.80mm) teeth and thicker band
material broader in width is used for premolars (0.12
4.55 mm) and molars (0.15 4.55mm).

-Step III Pinching the band


Band material of adequate length is cut and welded
at the ends

The band is adapted around the teeth using a band


pusher and

pinched using the band pinching pliers or a Howe


plier

The pinched band is removed from the tooth and


welded close to the pinched ends. Extra band
material is cut and bent in a distal direction and
welded

The margins are smoothered and gingival contouring


done on the mesial and distal gingival margins using
a dental stone

-Step IV Fixing the attachments


Attachments can be welded or soldered in place.
Welding is more commonly performed

-Step V Cementation of the band can be done


using any of
the luting cements. Adequate moisture control is
essential during cementation. Excess cement can be
removed using an explorer after the initial set of the
luting cement

BRACKETS
defined as a device that projects horizontally to
support auxiliaries and is open on one side usually in
the vertical or horizontal

Brackets are of various types depending upon the


technique used. Brackets can either be welded to
bands which are then cemented to individual teeth
or can be bonded. Bonding has its own inherent
advantages and disadvantages over banding

Edgewise brackets
Edgewise brackets have rectangular slots, which are deeper in the
horizontal as opposed to vertical plane. Slot and archwire dimensions have
traditionally been described empirically, with the original dimensions
being 0.022 inches vertically and 0.028 inches horizontally to
accommodate gold archwires, which were quite soft. Once stiffer stainless
steel archwires were introduced, slot size was reduced to 0.018 inches
vertically and 0.025 inches horizontally. However, with greater uptake of
pre-adjusted edgewise systems, there has been a move back to the
original slot dimension.

This allows increased dimensions of the working archwire and provides


better overbite and torque control during space closure with sliding
mechanics. Edgewise brackets are fabricated with a single archwire
channel and two tie-wings or more commonly as Siamese or twin brackets,
which have four tie-wings. Siamese designs have an increased bracket
width, which produces better control of tooth rotations and root position;
whilst the presence of two separate tie-wings allows partial ligation of
crowded teeth during initial alignment. However, the increased width of
Siamese brackets results in a reduced interbracket span and some
compromise in flexibility of the archwire during early alignment.

Edgewise brackets

Edgewise appliance

readjusted edgewise appliance.

Fully banded standard edgewise


appliances with space-closing loops
in the upper and lower archwires

Light wire appliance brackets


The original light wire appliance was the Begg
appliance, which utilized a simple bracket that was
identical for each tooth. Begg brackets incorporate a
narrow openended slot, into which a stiff round
archwire is placed from the gingival aspect and held
in position by the insertion of a small metallic
auxiliary lock pin

Begg bracket

Self-ligating brackets
In an attempt to reduce friction and appointment
times, a range of brackets whose slot is closed by the
use of a metal gate or clip are now available . This
technique is referred to as self-ligation, as the
ligation system is built into the bracket

self-ligating bracket with the gate


closed (left) and open (right).

Buccal Tubes Buccal tubes are horizontal


hollow tubes, round, rectangular or oval in shape.
They are generally used on molars and help provide
better three dimensional control of these anchor
teeth. They can be classified as:
a. Classification based on mode of attachment
Weldablecan be welded on-to bands
Bondablebonded directly to the tooth surface

Weldable molar tubes

Bondable molar tubes

b. Classified according to lumen shape as


Round
Oval
Rectangular
c. According to the number of tubes
Single

Begg tube, round or oval


Edgewise tube rectangular 0 tip and torque
values
Preadjusted edgewise rectangular with prescribed
in-out, tip and torque values

Round molar tube

Oval molar tube

Rectangular tube

Double molar tube (Edgewise),


Single molar tube

(pre-adjusted edgewise)

Lingual Attachments
are accessory attachments other than brackets and tubes
which are placed on the lingual aspect of teeth (bonded) or
bands (welded).
These include:

Lingual buttons: variable shaped bases for


attachment of elastics or elastomerics. Flat base for
centering on molars, curved for mesial or distal placement
on molars or extra-curved for use on premolars

Bondable lingual buttons

Lingual seating lugs: These help in seating of


bands. Are flat for anteriors and molars and curved
for cuspids and bicuspids.

Lingual seating lug welded to a premolar band

Lingual eyelets: These are used to tie elastic


threads or ligature wires. Hollow in the middle and
welded on the two sides.

Easy-threading eyelets

Lingual cleats: These are again used for


attachment of elastics or elastomerics. Are welded in
the middle with the ends being open, are also
available with a mesh base for bonding
Versatile precision cleats

Lingual sheaths: are used for attaching


accessories such as transpalatal arches, Ni-Ti molar
rotators and expanders

Lingual sheaths

Lingual elastilugs: are used for attaching


elastics and are available as curved for posteriors
and flat for anteriors. Both weldable and bondable
lugs are available
Elastilugs

Lingual ball hook: These are small balls


attached to a weldable flat arm. The offset can be
mesial or distal. They are used to attach elastics or
elastomeric chains/rings from the lingual aspect

Lock Pins
are either made of brass or soft steel. These are
used to hold the wire in bracket slots in the Begg
technique or accessories in the tip edge technique.

Ligature Wires:
Ligature wires are soft stainless steel wires of
0.008 to 0.010 inch in diameter. These may be used
to hold / ligate the archwire in brackets (Fig. 39.44A)
or to tie segments of teeth together

Ligature wire used to hold the


arch-wire in the bracket slot

THANK YOU

f. Magnets