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Similaire à IGNITE 2 Updated FINAL 29-3-2023.pptx
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IGNITE 2 Updated FINAL 29-3-2023.pptx
- 1. Dr. Chandrashekar B.S Professor, Department Of Orthodontics, Krishnadevaraya College Of Dental Sciences, Bangalore Director, Brace Station-Center For Advanced Orthodontic Needs, Bangalore Consultant, Al-Shifa Medical Centre, UAE
- 3. DISCLAIMER • All information presented here are according to literature and theoretical. • Clinical reality may be different.
- 4. • In Orthodontics, ligation method refers to the means by which an archwire is held within the bracket. • Conventionally, elastic or metal ties were used to hold the archwire in place; how ever more recently ligating methods have been designed and built directly into the brackets.
- 5. • Secureandrobustligation • Fullbracketengagement • Timeconsumingand discomfort • Lowfriction • Quickandeasyligation • Improvespatientcomfort • Secureandrobustligation • Fullbracketengagement • Lowfriction • Quickandeasyligation • Improvespatientcomfortandhygiene
- 6. WHAT IS SELF LIGATION? • Self-ligation brackets are ligature-less bracket systems that have a mechanical device built onto the bracket to close off the edgewise slot. • The cap holds the archwire in the bracket slot and replaces the steel/elastomeric ligature. Zreaqat M, Hassan R. Self-Ligating Brackets: An Overview. Principles in Contemporary Orthodontics. 2011 Nov 25;1.
- 8. Evolution and Revolution Bracket with multiple slots Bracket which is part of the philosophy Altered slot geometry Customization and use of AI in delivering individualized orthodontic treatment needs.
- 10. CLAIMS Transform extraction cases to non extraction by lateral expansion. Self ligating brackets are more efficient and effective than conventional edgewise bracket systems. Self ligating bracket systems provide less friction between archwire and bracket. Self ligating brackets provide lower clinical forces compared with conventional brackets. Patients treated with self ligating brackets experience less pain during treatment. Self ligating brackets are more hygienic than conventional brackets
- 11. Transform Extraction Cases To Non-Extraction By Lateral Expansion • DOES LATERAL EXPANSION OF THE DENTAL ARCH BY SLB GROW BUCCAL ALVEOLAR BONE. • ARE RESULTS COMPARABLE TO RME • ARE THE RESULTS STABLE. • WIDER SMILES BY NONEXTRACTION ARE MORE ESTHETIC • GOOD CONTROL ON THE INCLINATION OF INCISORS.
- 13. Expansive treatments to avoid extractions have been repeatedly examined and reaffirmed to be UNSTABLE!
- 14. WIRE SHAPE MAKES A DIFFERENCE • No difference in archwidth • No difference in axial inclination • It’s the wire and not the bracket.
- 16. Both conventional and SL brackets produced alignment-induced proclination of maxillary and mandibular incisors.
- 17. WHAT WE MAKE OUT FROM EVIDENCE DIAGNOSIS IS UNIVERSAL TRUTH AND IT CANNOT CHANGE WITH THE TYPE OF BRACKET USED. POOR EVIDENCE LINKING TEETH MOVING WITH BONE. STUDIES REGARDING LONG TERM STABILITY IS YET TO BE PUBLISHED.
- 18. SELF LIGATING BRACKETS ARE MORE EFFICIENT AND EFFECTIVE THAN CONVENTIONAL EDGEWISE BRACKET SYSTEMS. • CHAIRSIDE TIME • RATE OF ALIGNMENT • RATE OF SPACE CLOSURE • FASTER TREATMENT • BRACKET FAILURE • OCCLUSAL OUTCOMES • MANUFACTURING TOLERANCES
- 19. • Quicker archwire changes • Self-ligating systems offered quicker and more efficient wire removal and placement for most orthodontic stages.
- 20. • No difference in treatment time required to correct mandibular crowding with Damon2 and conventional brackets.
- 21. • Both treatment time and anchorage loss are not influenced by the type of bracket used.
- 22. • Damon SL brackets showed reduction in treatment time and no. of patient visits.
- 23. • Ligation method is not important
- 24. • More than 30 suppliers • Slop was 2.5 times more than predicted. • All methods of ligation were same. POOR DESIGN, MANUFACTURING LEADS TO POOR PERFORMANCE
- 25. WHAT WE MAKE OUT FROM EVIDENCE CHAIR SIDE TIME REDUCES SIGNIFICANTLY ALL OTHER CLAIMS HAVE POOR EVIDENCE AS OF NOW
- 26. SELF LIGATING BRACKET SYSTEMS PROVIDE LESS FRICTION BETWEEN ARCHWIRE AND BRACKET. • GOOD ANCHORAGE CONTROL 3
- 29. WHAT WE MAKE OUT FROM EVIDENCE MOST OF THE STUDIES ARE INVITRO AND IT IS DIFFICULT TO MIMIC THE CLINCICAL SITUATION.
- 30. SELF LIGATING BRACKETS PROVEDE LOWER CLINICAL FORCES COMPARED WITH CONVENTIONAL BRACKETS. • LOW AND CONTINUOUS FORCES NECESSARY FOR EFFECTIVE ORTHDONTIC TOOTH MOVEMENT. • LESS ROOT RESORPTION. • FASTER TOOTH MOVEMENT AS TEETH MOVES BY FRONTAL RESORPTION. • GREATER EXPANSION ALLOWS THE CONTROL ON INCISOR INCLINATION. • REDUCED AND LOWER FORCES PROMOTE ALVEOLAR BONE GENERATION AND ALLOW FOR GREATER LATERAL BONE EXPANSION.
- 31. • SL brackets delivered lighter forces when compared to conventional brackets. • An 0.014” archwire : • SL brackets – 125cN. • Conventional brackets – 810 cN.
- 33. WHAT WE MAKE OUT FROM EVIDENCE THE EVIDENCE IS STILL PRELIMINARY AND SHOULD BE INTERPRETED WITH CAUTION.
- 34. PATIENTS TREATED WITH SELF LIGATING BRACKETS EXPERIENCE LESS PAIN DURING TREATMENT. • COMFORT DURING INSERTION AND REMOVAL OF ARCHWIRES • DURATION OF PAIN • ACCEPTANCE FOR ORTHODONTIC TREATMENT
- 36. • SL brackets produced more pain and discomfort during insertion and removal of rigid rectangular archwires.
- 37. • Conventional brackets exhibited significantly more ‘constant’ pain than those treated with self-ligating brackets who complained on ‘chewing/biting’ pain.
- 38. WHAT WE MAKE OUT FROM EVIDENCE PAIN IS SUBJECTIVE FURTHER STUDIES REQUIRED TO ASCERTAIN THE CLAIM
- 39. SELF LIGATING BRACKETS ARE MORE HYGIENIC THAN SELF LIGATING BRACKETS.
- 40. • SL appliances reduced the bacterial retention when compared to conventional brackets.
- 41. Almeida et al. : No significant changes found with regard to the periodontal response between passive SL and conventional brackets.
- 42. WHAT WE MAKE OUT FROM EVIDENCE BRACKET DESIGN PLAYS A ROLE IN PERIODONTAL PARAMETERS
- 43. PROPONENTS OF SELF LIGATION OPPONENTS OF SELF LIGATION • John Lin • Kevin O’Brien
- 44. Suggested Reading • Textbook by Lin, John Jin-Jong, et al. • Creative Orthodontics: Blending the Damon System & Tads to Manage Difficult Malocclusions. • Textbook by Eliades, Theodore, and Nikolaos Pandis. • Self-Ligation in Orthodontics an Evidence-Based Approach to Biomechanics and Treatment. • Chen, S. S. H., Greenlee, G. M., Kim, J. E., Smith, C. L., & Huang, G. J. (2010). Systematic review of self-ligating brackets. American Journal of Orthodontics and Dentofacial Orthopedics, 137(6), 726-e1. • Fleming, P. S., & Johal, A. (2010). Self-ligating brackets in orthodontics: a systematic review. Angle Orthodontist, 80(3), 575-584. • Ehsani, S., Mandich, M. A., El-Bialy, T. H., & Flores-Mir, C. (2009). Frictional resistance in self-ligating orthodontic brackets and conventionally ligated brackets: a systematic review. The Angle Orthodontist, 79(3), 592-601. • Burrow, S. J. (2009). Friction and resistance to sliding in
- 45. CONCLUSION
Notes de l'éditeur
- WIRE AND BRACKET ARE COMRADES OF ORTHODONTIC TOOTH MOVEMENT WIRE GIVES FORCE AND BRACKET GIVES DIRECTION TO THIS TOOTH MOVEMENT. HOW WE TIE THE WIRE TO BRACKET IS CALLED LIGATION. THIS PRESENTATION IS ALL ABOUT THE INFLUENCE OF TYPE OF LIGATION ON THE PERFORMANCE OF TOOTH MOVEMENT. TRADITIONALLY WE USE LIGATURE WIRE OR ELASTIC MODULE FOR THIS PURPOSE
- LIGATURE WIRE- LESS FRICTION, CONTROL ON THE AMOUNT OF ACTIVATION, TIME CONSUMING AND PUNCTURE WOUNDS ON THE MUCOSA OF PATIENTS. ELASTIC LIGATURES- FASTER LIGATION, MORE COMFORTABLE TO PATIENT. MIGHT LOOSE THE EXPRESSION DURING CERTAIN MECHANICS BECAUSE OF WIRE MIGHT COME OUT OF THE SLOT. TO MAXIMISE THE ADVANTAGES OF BOTH THE TYPES OF LIGATION, SELF LIGATION WAS INTRODUCED.
- IN SIMPLE TERMS, U ADD A SLIDE OR SHUTTER TO EDGEWISE BRACKET. IT BECOMES SELF LIGATING BRACKET.
- Depending upon the force exerted by the slide to seat the wire in the slot U CAN CLASSIFY ACTIVE AND PASSIVE. INTERACTIVE- ACTS LIKE PASSIVE IN CERTAIN STAGES AND ACTIVE IN CERTAIN STAGES.
- When orthodontist all over the world were asked regarding what is the most important innovation which has changed the way orthodontics has been practiced, slb was the third most important innovation. With more and more orthodontist adopting slbs in their practice, more and more companies are coming with newer brackets. we should have a thorough understanding on how and why we choose a particular system or bracket.
- Companies make various claims as the competition is intense. It becomes important for us to understand why are we paying premium of almost 2 to 10 times the cost of conventional brackets.
- To treat a patient without extracting teeth, the most common method employed is expansion and uprighting the teeth without causing undue proclination. So it becomes important for us to understand the type of expansion produced by slbs, is it different when compared to rme. Are they stable on long term.
- Dr john lin text book Dr Maurice Rodrigues- cbct study of the mandibular dentition with crowding. Comparison of cb and slb were done to assess the transverse changes and buccal bone thickness following the initial phase of treatment. The results were like both cb and slb had same buccal bone thickness at the end of observation period.fc
- Robert little- only 6 pts out of 26 pts maintained the gained arch length. Mcnamara- rme, rme with schwarz and control, rme with schwarz had favourable results.
- Dr ezgi atik et al It’s the archwire which is important and not the type of bracket Had three groups- conventional, active self ligating and passive self ligating brackets.
- Extraction treatment is usually critisised for creating dished in profiles, increased buccal corridor spaces, flatter smile, reduced arch length and width. We have 4 renowned authors published in reputed journals confirming that appropriately planned extraction treatment doesn’t cause any ill effects. Dr Anthony gianelly, Dr kim, Jay bowman and Boley.
- Nicholas pandis and Adrian candida Compared slb with conventional ligation Cephs were used to check the pre and post treatment inclinations of maxillary and mandibular incisors. Cbs and slbs were comparable in the values and no much difference.
- Nicholas turnbull and his associates have done this study comparing the damon slb with conventional ligation Archwire changes were quick with slbs, opening the shutter was 1 sec quick and closing the shutter was 2 sec quicker. As we progress to thicker wires the insertion and removal was faster with slbs when compared to cb
- Nicholas pandis and his collagues No difference in time to align the teeth between cb and slbs When crowding was mild slbs were faster but as the crowding increased, the time taken by slbs were more than cbs
- Ferdinand machibaya and his colleagues Smart clip and victory series brackets were compared Treatment time reduction was almost two months which is not statistically significant. Anchor loss was same with both the bracket systems The dental and skeletal effects were similar.
- Harridane and tuncay Slb evaluated was damon system It’s a retrospective study The reduction in treatment time was almost four months. Pts had to make fewer visits, improved occlusal outcomes, happier pts with less pain and fewer extractions.
- In total 9 RCTs have been summarized in the article. None of the studies indicate that ligation method is important to have better efficiency.
- Birte melson and Michael dastra Evaluated for torque from 32 different manufacturers Had a slop of 2.5 times more than predicted. Method of ligation did not have effect on torque expression.
- Max Hain- Damon 2 brackets and speed had less friction Birte melson and associated- on orthodontic simulator varied the angulations and found that damon brackets had lesser friction when compared to cbs
- Meta analysis of 6 eligible studies Both brackets showed the same rate of canine retraction and anchor loss
- Kusy et al 4 slbs and 4 cbs were used Orthodontic simulator with varying malocclusion on typhos was used.
- To conclude. Remember that everything in science including the science of orthodontics is dynamic and evolving. What is true today might be true only today. By tomorrow it may be replaced with another truth. Learn, evolve and be willing to change with the changing times.