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FIXED ORTHODONTIC APPLIANCES
Prepared and Presented By:
Musab A.ra!an
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DEFINITION:
Are attachments that are fxed to the tooth
surace, the orces are exerted via theattachments using arch wires and/or other
auxiiaries thus are ca!a"e o greater range o
movements than that o the remova"e ones#
It cannot "e ad$usted neither removed "% the
!atients
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AD&ANTA'E(:
Precise tooth control
Is !ossi"e "ecause its !ossi"e to move theteeth in ) !anes o s!ace so achieving!erect aignment o teeth "oth inter and intraarch
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Multiple tooth movement are possible:
*#Individua tooth can "e moved in ) !anes os!ace simutaneous% e#g: a tooth can "eintruded and retracted simutaneous%
+#Dierent teeth can "e moved at the sametime in dierent directions e#g one can "ederotated whie the other is retracted
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Patient cooperation is reduced com!ared to
that o the remova"e a!!iance
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DI(AD&ANTA'E(
Oral hygiene requirements:
It "ecomes diicut as the ood de"ris tends to
accumuate around the attachments
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Esthetics:
Fixed a!!iances are genera% made out o
metas so not esthetica% acce!ted "% most!atients# The advent o ingua techni-ue andtooth coored "rac.ets have he!ed toovercome this advantage so ar#
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Requires special training for the operator
athough sim!e cases can "e done "% a '01 Expensive
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Increases the chair side time:
(ince its fxed and cant "e removed "% the
!atient a the modifcations and ad$ustmentsshoud "e done "% the dentist
(o increasing the time
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Anchorage control is diicut com!ared to
that o the remova"eTtt monitoring is diicut as the !atient
must "e recaed in reguar visits or
ad$ustments/reactivators
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Fixed orthodontic a!!iances are indicated
whenever muti!e tooth movement is re-uired:
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orrection of mild to moderate s!eletal
discrepancies As fxed a!!iances can "e usedto achieve "odi% movement it is !ossi"e,
within imits, to com!ensate or s.eeta
discre!ancies and treat a greater range o
maoccusions#
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Intrusion"extrusion of teeth &ertica
movement o individua teeth, or toothsegments, re-uires some orm o attachment on
the tooth surace onto which the orce can act#
orrection of rotations
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Overbite reduction "% intrusion o incisors
Multiple tooth movements re-uired in one
arch
Active closure o extraction s!aces, or
s!aces due to h%!odontia Fixed a!!iances can
"e used to achieve "odi% s!ace cosure and
ensure a good contact !oint "etween the teeth
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2ONT3AINDI2ATION(
:
Poorly motivated patient:
As the !atient4s res!onsi"iit% os not imited to
maintaing a good ora h%giene "ut wi asoinvove eastic and headgear wearing and.ee!ing a!!ointments at reguar intervas
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Poor dental health:
!atients with !oor denta h%giene are i.e% to
suer rom !eriodonta deiseases
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Malocclusions beyond the scope of #OA
e#g s.eeta $on specifcialists, on% orthodontists are
-uaifed to im!art ttt using FOA
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2O50ONENT(:
Active
passive
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A2TI&EThese incude com!onents which are ca!a"e
o generating tooth moving orces# These
incude:a# (e!arators # 5agnets
"# Archwires
c# Eastics
d# Eastomerics
e# (!rings
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(e!erators are used to create s!ace "etween
+ ad$acent teeth genera% to "and them6as severa t%!es:
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73A(( 8I3E
Initia sot "rass wire 9# to 9#;mm !assed
interdenta% and twistedThe% were !ainu, caused acerations due to
the uncontroed orced
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7rass se!arators in
!ace media anddista to the maxiar%et frst moar
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=E((IN'
(E0E3ATO3
are made o 9#9*;? s!ecia !us Austraian
wire with heices at the cosed end# The o!enstraight arm !asses "eow the contact
suicient s!ace is created within @ hours o
a!!ication
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The short arm othe se!arator ished in a
8eingart !ier
The ong, hoo.edarm is !aced
under thecontact !oint andthe short arm is!ued atera% "%the !ier
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The se!arator is rotated into !ositionwith the ong,hoo.ed arm o the se!arator over thecontact !oint and theshort arm under the contact !oint
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3IN' (E0E3ATO3(
Are sma eastic rings that are stretched and
!assed through the interdenta contacts using
se!arators4 !acing !ier
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Easticse!arators# Theose ones have
a rectanguarcut sectionwhereas theones on thestic. are round
0acement o eastomericse!arators using dentaoss# Two !ieces o oss are!aced through the hoe in thecenter o the se!arator and arehed one in each hand
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The se!aratorB
!acing !ier
(nug% ftting eastic
se!arators
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A326 8I3E(
Are avaia"e in various dimentions and
materias
0h%sica !ro!erties:
%pringbac!: a"iit% to return to its origina
sha!e ater an a!!ied orce
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%ti&ness: amount o orce re-uired to "end
or deect the wire
#ormability : ease in which the wire "ends
into the desired sha!e
Resilience: stored energ% remaining ater
deection w/o !ermanent deormit%
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'iocompatibility
(oint ability : whether the materia can "eweded or sodiered
#rictional characteristics
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CaCr TMA NiTi ss
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T>0E(
%tainless steel
(tainess stee is an ao% consisting o iron, chromium and
nic.e, which has a arge moduus o easticit%# As such, stainess
stee archwires are genera% sti and resist deormation, which
ma.es them idea as wor.ing archwires, exi"iit% o stainess
stee archwires can "e increased "% winding severa smaer
wires together to orm arge mutistrand or twistex wiresC or
wra!!ing smaer wires around a arger centra wire to !roduce a
coaxia wire
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obalt chromium
2ommercia% mar.eted as Egio%, co"at chromium
has a greater orma"iit% than stainess stee andsimiar stiness, "ut with greater riction# It can "ehardened "% heatBtreating in the a"orator% and isused or the construction o auxiiaries, such as anintrusion arch or -uadheix#
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'eta titanium
Introduced in the *G9s, "eta titanium wires have
good orma"iit%, with a stiness o around oneBthirdthat o stainess steeC "ut the% are aso associatedwith higher
riction# These archwires are used in the f na stageso treatment, when fnishing "ends ma% "e re-uiredto detai individua tooth !osition and achieve
setting o the occusion#
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$ic!el titanium
Nic.e titanium or H NiTi 4 archwires are
characteried "% high exi"iit% and the deiver% oow orce over ong range# The% aso exhi"it the!henomenon o sha!e memor%C when deormed the%wi tend to return to their origina sha!eC andsu!ereasticit%, the wire deivering the same orceover a arge range o deormation
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These wires are idea or aigning teeth during theinitia stages o treatment# 6owever, the !ro!erties
o ow stiness and !oor orma"iit% ma.e nic.etitanium an unsuita"e materia or ater stages otreatment where a stier archwire is re-uired ors!ace cosure and over"ite contro#
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E
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classI :
Are intra arch main% !aced "etween the
moars and incisors in the same arch to cosethe extraction s!aces "% retracting anteriorteeth or !rotracting the !osterior
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2ass I eastics, the horionta%!aced greeneastics seen in the a"ove and"eow !hotogra!hs
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classII :
Are intermaxiar% !aced "etween mandi"uar
moars and maxiar% anteriors, can "e used to!roduce intrusion o max# anterior 7eggthera!% stage*1 or decrease the over$et "%retraction o the max# anterior
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2ass II eastics are!aced "etween the
mandi"uar moars andthe maxiar% anteriors
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lass III :
Are intermaxiar% !aced "etween maxiar%
moars and mandi"uar incisors, genera% inthe TTT o ange cass III maoccusions
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2ass III eastics
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)iagonal elastics:
8orn or midine deviation correction
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6orionta !in. coored
eastics are 2ass I eastic
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ross*bite elastics
Are intermaxiar% and used to correct cross
"ite in the "ucca segment and !acedaccording to the tooth in cross "ite, genera%rom the !aata surace o the maxiar% moarsor !remoars to the "ucca o the ower moarsor !remoars
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2ross "ite eastics
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'ox elastics: used to correct the anterior
o!en "ite, the% extend "etween max# and man#
2ausing the dista ti!!ing o the maxiar%
anterior and/or orced eru!tion o max# and/or
mand anteriors
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7ox eastic
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Extra*oral elastics: are used in con$uction
with extraBora a!!iances i.e a ace mas.
It usua% exerts high orces 9#G to *@ o1
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ExtraBora eastics
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E
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Elastic thread or cotton thread:
5ade rom s!ecia t%!e o cotton and are used
to correct the deBrotations, consoidation oanterior s!ace
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Figure o G !acement o the cotton thread
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Elastic ligature:
Jsed to secure the arch wires in edgewise or
!re ad$usted edgewise "rac.ets#
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Elastic modules or elastic lin!s
Are made o + eastic rings se!erated "% a
varia"e distance, avaia"e in dierent sies
"ased on the interBring distances, are genera%
used to cose s!aces or deBroation o anterior
teeth
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(03IN'( &arious t%!es o s!rings are used as auxiiariesto generate tooth moving orces, are main%used or tooth u!Brighting and tor-ueing in
"eggs a!!iance thera!%, ti! edge a!!iances#(!ring ma%"e used to o!en s!aces o!en cois!ring1 or cose s!aces cosed coi s!ring1
6as the oowing t%!es:
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+p righting springs:
5ade o 9#9*+44 or 9#9*@44 Austraian wire,
the% move the tooth root in a mesia or dista
direction
5esiodistau!rightings!rings
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Rotating spring: !rovides or a sim!e and
eective means or deBrotating teeth without the
remova o the arch wire, the% are ca!a"e o
coc.wise or anticoc.wise motion according to the
design
3otatings!rings
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Torquing spring:
2a!a"e o moving the root a"ia/ingua or !aata
in direction, the orce is generated when the s!ring
is deormed and engaged aong the arch wire
Tor-uing s!ring used or"uccoinguaroot movement
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'oodman Tor-ueing (!ring
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Open coil spring:
Are either made o (( or NiTi ao%s# The orce
exerted de!ends on the diameter o the wire o
which its made o, its used s!ring o a!!ro!riate
ength is com!ressed "/w + or more teeth to o!en u!
its !oints o attachment
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O!en coi s!ring in !ace
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losed coil spring:
5ade o stainess stee or nic.e titanium ao%s#
The% are used to cose s!aces# Once the s!ring isstretched and attached at two ends, it tries toachieve its !rea"ricated ength "% cosing the ga!"etween its !oints o attachment
2osed coi s!ring stretched rom themoar, !remoars to canine "rac.etor the retraction o the canine
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0A((I&E
Are those com!onents which are not ca!a"e o
generating tooth movement orces "ut he! in
!roviding attachments or other auxiaries to the
tooth or retaining other active com!onents
AB7ands
7B7rac.ets
2B7ucca tu"es
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DB ingua attachments "uttons, seating ugs, ceats,sheaths, "a hoo.1
EB oc. !insFB igature wires
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7AND(
Are either costume a"ricated or commercia%
made sies
Are meta attacments encirces the tooth1 that are
cemented and !rovides a !ace or attachments o
other auxiaries which can "e either weded or
soidered to the "and
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Indications:*Bteeth that wi receive heav% intermittent orcesagainst the attachments !rimar% indication1 e#gu!!er *st moar against extraora orces wi "e!aced via a head gear
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+B teeth that wi need "oth a"ia and inguaattachments e#g a moar with "oth headgear andingua arch wires
)B teeth with short cinica crowns
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(te!s o "anding:
-Step I Separation of adjacent teeth:
can "e achieved using se!arators or a duration o +to K da%s de!ending u!on the se!arator used#
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-Step II Selection of band material
Thinner "and materia esser in width is used or
anterior 9#9*9 L )#G9mm1 teeth and thic.er "andmateria "roader in width is used or !remoars 9#*+L @# mm1 and moars 9#* L @#mm1#
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-Step III Pinching the band
7and materia o ade-uate ength is cut and wededat the ends
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The "and is ada!ted around the teeth using a "and!usher and
!inched using the "and !inching !iers or a 6owe!ier
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The !inched "and is removed rom the tooth andweded cose to the !inched ends# Extra "andmateria is cut and "ent in a dista direction andweded
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The margins are smoothered and gingiva contouringdone on the mesia and dista gingiva margins usinga denta stone
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-Step IV i!ing the attachments
Attachments can "e weded or sodered in !ace#8eding is more common% !erormed
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-Step V Cementation of the band can be done"sing an# of
the uting cements# Ade-uate moisture contro isessentia during cementation# Excess cement can "eremoved using an ex!orer ater the initia set o theuting cement
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73A2=ET(
defned as a device that !ro$ects horionta% to
su!!ort auxiiaries and is o!en on one side usua% in
the vertica or horionta
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7rac.ets are o various t%!es de!ending u!on the
techni-ue used# 7rac.ets can either "e weded to
"ands which are then cemented to individua teeth
or can "e "onded# 7onding has its own inherent
advantages and disadvantages over "anding
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Edge,ise brac!ets
Edgewise "rac.ets have rectanguar sots, which are dee!er in the
horionta as o!!osed to vertica !ane# (ot and archwire dimensions have
traditiona% "een descri"ed em!irica%, with the origina dimensions
"eing 9#9++ inches vertica% and 9#9+G inches horionta% to
accommodate god archwires, which were -uite sot# Once stier stainess
stee archwires were introduced, sot sie was reduced to 9#9*G inches
vertica% and 9#9+ inches horionta%# 6owever, with greater u!ta.e o
!reBad$usted edgewise s%stems, there has "een a move "ac. to the
origina sot dimension#
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This aows increased dimensions o the wor.ing archwire and !rovides
"etter over"ite and tor-ue contro during s!ace cosure with siding
mechanics# Edgewise "rac.ets are a"ricated with a singe archwire
channe and two tieBwings or more common% as (iamese or twin "rac.ets,
which have our tieBwings# (iamese designs have an increased "rac.et
width, which !roduces "etter contro o tooth rotations and root !ositionC
whist the !resence o two se!arate tieBwings aows !artia igation o
crowded teeth during initia aignment# 6owever, the increased width o
(iamese "rac.ets resuts in a reduced inter"rac.et s!an and somecom!romise in exi"iit% o the archwire during ear% aignment#
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Edgewise "rac.ets Edgewise a!!iance
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Fu% "anded standard edgewisea!!iances with s!aceBcosing oo!s
in the u!!er and ower archwires
read$usted edgewise a!!iance#
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-ight ,ire appliance brac!ets
The origina ight wire a!!iance was the 7egg
a!!iance, which utiied a sim!e "rac.et that wasidentica or each tooth# 7egg "rac.ets incor!orate anarrow o!enended sot, into which a sti roundarchwire is !aced rom the gingiva as!ect and hedin !osition "% the insertion o a sma metaicauxiiar% oc. !in
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7egg "rac.et
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%elf*ligating brac!ets
In an attem!t to reduce riction and a!!ointment
times, a range o "rac.ets whose sot is cosed "% theuse o a meta gate or ci! are now avaia"e # Thistechni-ue is reerred to as seBigation, as theigation s%stem is "uit into the "rac.et
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seBigating "rac.et with the gatecosed et1 and o!en right1#
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'uccal Tubes 7ucca tu"es are horionta
hoow tu"es, round, rectanguar or ova in sha!e#
The% are genera% used on moars and he! !rovide
"etter three dimensiona contro o these anchor
teeth# The% can "e cassifed as:
a# 2assifcation "ased on mode o attachment
M 8eda"ecan "e weded onBto "andsM 7onda"e"onded direct% to the tooth surace
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8eda"e moar tu"es
7onda"e moar tu"es
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"# 2assifed according to umen sha!e as
M 3ound
M OvaM 3ectanguar
c# According to the num"er o tu"es
M (inge
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M 7egg tu"e, round or ova
M Edgewise tu"e rectanguar 9 ti! and tor-ue vaues
M 0read$usted edgewise rectanguar with !rescri"edinBout, ti! and tor-ue vaues
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3ound moar tu"e Ova moar tu"e
3ectanguar tu"e
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(inge moar tu"e
Dou"e moar tu"e Edgewise1,
!reBad$usted edgewise1
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-ingual Attachmentsare accessor% attachments other than "rac.ets and tu"eswhich are !aced on the ingua as!ect o teeth "onded1 or
"ands weded1#These incude:
-ingual buttons: varia"e sha!ed "ases or
attachment o eastics or eastomerics# Fat "ase or
centering on moars, curved or mesia or dista !acementon moars or extraBcurved or use on !remoars
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7onda"e ingua "uttons
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-ingual seating lugs: These he! in seating o
"ands# Are at or anteriors and moars and curved
or cus!ids and "icus!ids#
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-ingual eyelets: These are used to tie eastic
threads or igature wires# 6oow in the midde and
weded on the two sides#
Eas%Bthreading e%eets
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-ingual cleats: These are again used or
attachment o eastics or eastomerics# Are weded in
the midde with the ends "eing o!en, are aso
avaia"e with a mesh "ase or "onding
&ersatie !recision ceats
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-ingual sheaths: are used or attaching
accessories such as trans!aata arches, NiBTi moar
rotators and ex!anders
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-ingual elastilugs: are used or attaching
eastics and are avaia"e as curved or !osteriors
and at or anteriors# 7oth weda"e and "onda"e
ugs are avaia"e
Eastiugs
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-ingual ball hoo!: These are sma "as
attached to a weda"e at arm# The oset can "e
mesia or dista# The% are used to attach eastics or
eastomeric chains/rings rom the ingua as!ect
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$oc% Pins
are either made o "rass or sot stee# These are
used to hod the wire in "rac.et sots in the 7egg
techni-ue or accessories in the ti! edge techni-ue#
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-igature .ires:
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T6AN= >OJ
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# 5agnets