Fixed Orthodontic Appliance (Dentistry) #Braces

#ORTHODONTIC
Fixed Appliances
DR. SARANG SURESH HOTCHANDANI| CHAPTER 10

Contents
 Introduction to Fixed Appliances
 Indications & Contraindications of Fixed Appliances
 Difference b/w Fixed & Removable Appliances
 Types of Fixed Appliances
 Orthodontic Bends in Fixed Appliances
 Components along with Placement Removal of Fixed Appliances
 Prevention & Treatment of White Spots after Orthodontic Tx.
 Problems with Fixed Appliances
 Temporary Anchorage Devices
4/4/2017DR. SARANG - S - HOTCHANDANI
2

Orthodontic Appliances
Fixed Orthodontic Appliances 
Functional Orthodontic Appliance
Removable Orthodontic Appliances
3

Introduction to Fixed Appliances
 These are orthodontic devices, which have attachments that
are fixed onto the tooth surface, and force are exerted on
tooth via these attachments using arch wires and other
auxiliaries.
 These appliances cannot be removed or activated by
patient.
4

Indications of Fixed Appliances
 Correction of mild to moderate
skeletal discrepancy.
 Intrusion/Extrusion of teeth.
 Corrections of rotation.
 Overbite reduction by intrusion
of incisors.
 Multiple tooth movements
required in one arch.
 Active closure of extraction
space, or space due to
Hypodontia.
5

Contraindications of Fixed Appliances
Poorly motivated patient
Poor dental health
Extremely sever malocclusion requiring
orthognathic surgery
6

Fixed V/S Removable Appliances
FIXED APPLIANCE REMOVABLE APPLIANCE
Precise 3 dimensional tooth movement Less precise control of tooth movement
Bodily tooth movement Tipping tooth movement only
Complex malocclusions can be treated Simple malocclusions only
High anchorage requirements Small anchorage requirements
Controlled space closure possible Space closure is difficult
Multiple tooth movements Few tooth movements
Can be used in upper or lower arch Retention in lower arch is poor
Simple to correct rotations More difficult to correct rotations
Oral hygiene can be problematic Can be removed for oral hygiene
Not dependent on patient’s compliance Depend on patient’s compliance
Long chairside time Short chair side time 4/4/2017DR. SARANG - S - HOTCHANDANI
7

Fixed Appliances
 Contemporary fixed appliances are variations of Edge wise appliance system.
 Another system of fixed appliance is Begg appliance system.
 It contains rectangular slot but does not use rectangular arch wire.
 Currently Begg appliance system has been modified into Tip – Edge appliance system.
8

Fixed Appliances
Edgewise
Standard
Edgewise
Contemporary
/Straight Edgewise
Begg Appliance
Tip Edge
Appliance
9

Ribbon Arch
 It was made by Edward Angle.
 It contains vertically positioned
rectangular slots in which arch wire of
10x20 gold wire was placed into the
vertical slots and held with pins.
 It had poor control of root position
and does not generated torque.
10

Edgewise
 angle modified that ribbon arch appliance, in
which he Reoriented the slot from vertical to
horizontal and inserted a rectangular wire
rotated 90 degrees to the orientation it had
with ribbon arch, thus the name edge wise.
 The dimension in that slot were 22 x 28 mils
& wire of 22 x 28 mil precious metal was
used.
11

Begg Appliance
 It is a modification of ribbon arch appliance, in which Raymond Begg modified
following things in the appliance.
 He replaced the precious metal ribbon arch with 16 mils round stainless steel wire
 He retained original ribbon arch bracket, but turned it upside down so that the bracket
pointed gingival rather occlusally.
 He added auxiliary springs to the appliance for control of root position & cause rotation in
tooth.
12

Advantages & Limitations of
Begg Appliance
 Advantage of Begg Appliance
 Tipping movement
 Bite opening
 Friction was minimized
 Binding was minimized (mentioned in chapter 9)
 Limitations of Begg Appliance
 Finishing
 Cumbersome Technique
13

Tip Edgewise Appliance
 It is a hybrid appliance having combination of Begg & Edge wise
mechanics (straight wire mechanics of edge wise)
 It allows tipping of tooth in the initial stages of treatment with
round wires – Begg technique.
 In latter stages, rectangular wires are used for final tooth positioning.
14

Contemporary
Edgewise
Appliances
15

Modern edgewise appliances are of two
types;
Standard/Original Edge wise appliance
system
Straight wire/ Contemporary edgewise
appliance system
16

STANDARD EDGEWISE APPLIANCE
SYSTEM
 Rotation of tooth was controlled by
separate ligatures tied to the eyelets
soldered to the corners of bands
 Bracket slot size was 22 x 18
 Same bracket on all teeth
 That’s why bends were given to
compensate for difference in tooth
anatomy.
17

Bends in Standard Edgewise
18

1st order Bend OR in – out bend OR
facio – lingual bends
 This bend was given to compensate for variation in the contour of
labial surface of individual teeth (differing tooth width &
buccolingual direction of teeth).
 These bends are given in horizontal or in the plane of arch wire.
 Can be given in rectangular or round wire
19

2nd order bend/ tip bends/ artistic positioning
bends
 These bends were given to achieve proper mesiodistal root
position or tilting of teeth.
 They are given in vertical plane
 Can be given in rectangular or round wire.
20

3rd order bends/ torque bends
 These bends are given only in rectangular wire.
 These bends are made by twisting the wire and is inserted into
bracket slot so that is can exert Bucco lingual force on the root
apex.
 These bends were given for moving the roots facially or lingually
and also to avoid movement of properly positioned teeth. 4/4/2017DR. SARANG - S - HOTCHANDANI
21

Orthodontic
Bends
a) 1st order bend
b) 2nd order bend
c) 3rd order bend
22

“
”
Straight wire Edge
Appliance
23

Straight wire edgewise appliance
 They are modern edgewise appliances
 In these appliance rotation is not controlled by separate ligature but
it is built in the bracket itself.
 Bracket slot size is available in two forms;
 18 x 28 mills & 22 x 28 mill slot size.
24

 Different brackets for different teeth.
 This thing eliminated the bends which were given in standard edgewise.
 In these appliances no any 1st order bend is given, instead, compensation for the
contour of labial surface of teeth is built into the base of bracket.
 In straight arch wire appliances, positioning of root is accomplished by proper
angulation of bracket or bracket slot.
 This thing decreased the need for 2nd order bends. 4/4/2017DR. SARANG - S - HOTCHANDANI
25

The bracket slots in the straight wire edgewise
appliances are inclined to compensate for proper
inclination of facial surface, so that’s why 3rd order
bends are not given.
26

Straight wire
edgewise
appliance
Diagram (a) shows an edgewise
bracket with a 2nd order bend
placed in the arch wire to achieve
the desired movement of tip.
Diagram (b) shows a pre –
adjusted bracket with tip built into
the bracket slot.
27

Components of Fixed Appliances
Bands Bonds/ Brackets
Orthodontic Adhesive Auxiliaries
Arch wires
28

Orthodontic
Bands
29

Orthodontic Bands
 These are the rings which encircle the tooth & to which buccal and/or lingual
attachments are soldered or welded.
 Before acid etching technique, brackets were attached on bands which are
then cemented on tooth.
 They are not used now days except only on molar teeth.
30

Indications Where Brackets Are Still Applied
On Bands
 Teeth that will receive heavy intermittent
force;
 maxillary 1st molar in which force is applied via
headgear
 Teeth that will need both labial and lingual
attachments
 Molar with both headgear and lingual arch
tube.
 Isolated lingual bracket.
 Teeth with short clinical crowns
 Teeth with extensive restoration
 Bond strength is low on restorations.
 De bonding from porcelain damages
its appearance.
31

Rules of
Banding & Bonding in Contemporary
Orthodontics
32

Steps in Placement of Orthodontic Bands
Separation
Fitting
Cementation
33

Separation
 Teeth must be separated before banding, because tight inter proximal contacts
make it impossible to properly seat a band.
 Principle of Separation; a device to force or wedge the teeth apart is left in
place long enough for initial tooth movement to occur, so that the teeth are
slightly separated by the appointment at which bands are to be fitted.
34

Methods of Separation
Separating Springs
Elastomeric Separators /
doughnuts
35

Separating Springs
 They exert scissor action above and below the contact.
 Open the contact points within 1 week. Should not be placed more than 1 week.
 Easier to tolerate.
 Disadvantages; these separators tend to become loose & fall out as they
accomplish their purpose.
36

Method of Separation with Steel
Separating Spring
A. The spring is grasped at the base.
B. The bent – over end of the longer leg is placed in lingual embrasure, and the
spring is pulled open so the shorter leg can slip beneath the contact.
C. The spring in place, with the helix to the buccal.
D. The spring can be removed most easily by squeezing the helix, forcing the legs
apart. 4/4/2017DR. SARANG - S - HOTCHANDANI
37

Method of Separation with Steel
Separating Spring
38

ELASTOMERIC SEPARATORS
(DOUGHNUTS)
 They surround the contact point & squeeze the teeth apart.
 More difficult to insert but they are retained for long time without
fall.
 Always use bright colored elastomeric separators because they
are radiolucent.
 They should be placed not more than 2 weeks.
39

Method of Separation with Elastomeric
Ring
 The elastomeric ring is placed over the beaks of a special pliers and stretched, then
 one side is snapped through the contact and the pliers slipped out so that the doughnut now surrounds the
contact; C,
 an alternative to the special pliers is two loops of dental floss, placed so they can be used to stretch the ring.
 The dental floss is snapped through the contact and the doughnut is pulled underneath the contact;
 the doughnut is pulled upward, and the doughnut is snapped into position. At that point, the dental floss is
removed.
40

Method of Separation with Elastomeric
Ring
41

Fitting the Bands
Maxillary molar band placement
 placed initially by hand pressure on the
mesial & distal surfaces. After placement
 pressure is applied on mesiobuccal and
distolingual surfaces.
 Final seating is with heavy biting force by
patient on the distolingual corner.
Mandibular molar band placement
 Seated initially with hand
pressure on proximal surfaces
and then with
 Heavy biting force along the
buccal but not lingual margins.
42

Cementation of Molar Bands
 All interior surfaces of orthodontic band must be coated with cement
before it is placed.
 Place a gloved finger over the top of the band when it is carried to
place, to help in keeping cement on the gingival aspect of band.
 Cement Materials;
 Zinc phosphate
 GIC
 Resin modified GIC
43

Orthodontic
Brackets
44

Brackets
They are appliances that are fixed to
crown & mediate forces applied by
the arch wire & auxiliaries on tooth.
45

Types of Brackets
MATERIALS
 Cast or metal injected molded
stainless steel brackets
 Titanium brackets
 Cobalt chromium brackets
 Ceramic brackets
DESIGN
 Edgewise bracket/ straight wire
 Light wire appliance brackets/ tip edge
bracket
 Self-ligating brackets
 Lingual brackets
46

Components of Brackets
• 18 x 18 or
22 X 18
Wings Slots
BaseMesh
47

Bonding of Bracket
 Bonding is based on the mechanical locking
of an adhesive to irregularities in the enamel
surface of the tooth and to mechanical locks
formed in the base of bracket.
 Brackets are mechanically bonded to tooth
surface. Chemical bonded is avoided because
it will create problems in debonding of
bracket
 Bonding Materials in
Orthodontics
 Light cured bis – GMA resin
 Self-cured or light cured
composites
 GIC
 Less decalcification because of fluoride
release
 Less strength & greater chance of loos
brackets
48

Types of Bonding Bracket
DIRECT BONDING
 places the brackets on the teeth
individually at the chairside; and
 Advantages; easier, faster, less expensive
 Disadvantage; no proper position of
bracket
INDIRECT BONDING
 places the brackets on study models in the
laboratory and these are transferred to the teeth
using a positioning tray. it is used when placing
lingual fixed appliances.
 Advantages
 greater accuracy of bracket positioning
 Disadvantage
 extra cost and time
49

1)Cleaning the tooth
surface, to remove any
pellicle using a slow
hand piece and prophy
brush or cup;
1)Acid-etching the
enamel surface using
37% unbuffered
phosphoric acid for 20
– 30 seconds;
Washing and drying
the tooth surface
1)Placing unfilled
primer on the etched
area of the tooth;
Placing composite resin
on the bracket base
Positioning the bracket
on the tooth crown
Cleaning up excess
composite from around
the bracket base
Curing the composite,
either chemically or
with a blue light source
Steps in
Direct Bonding
of Bracket
50

51

INDIRECT
BONDING
52

1)The teeth are isolated, etched, and a chemically cured two-paste resin is painted on the etched enamel
and the brackets. Then, the transfer trays are inserted. D, After the resin has completely set, the trays are
carefully removed, leaving the brackets bonded to the teeth.
After the brackets are cured in the ideal position, a transfer tray is formed from a vinyl polysiloxane putty
The trays are removed from the working cast after soaking in warm water and trimmed
1)Brackets are placed precisely as desired on a cast of the teeth and held in place with a filled resin.
53

54

De Banding &
De Bonding
55

Removal of Molar Band
Distort the band with force which
will break the cement away from
band & tooth and remove it.
56

Removal of Bracket
 When bracket is one of the following things happen;
 Breakage b/w cement & bracket (preferred)
 Breakage within the cement material itself
 Breakage b/w enamel surface & cement (least desired)
 The safest way to remove metal bracket is to distort the bracket base, which cause breakage b/w
bracket & cement.
 This damages the bracket and it cannot be reused.
 Ceramic brackets on removal damages the enamel because they break before bend. 4/4/2017DR. SARANG - S - HOTCHANDANI
57

“
”
Prevention & Treatment of Enamel
Decalcification/White Spots after
Orthodontic Tx.
58

Prevention
 Fluoridated water & fluoride containing toothpaste
0.05% neutral sodium fluoride rinse
 Caries Prone patient; fluoride varnish application at 6-month interval
 Chlorhexidine mouthwash for 14 days.
59

Remineralization
Therapy
External Bleaching
Micro Abrasion
Veneers
60

Characteristics of Contemporary Brackets
– CERAMIC BRACKETS
 Durable, resist staining, dimensionally stable
 Types of ceramic bracket based on the material;
 Polycrystalline alumina
 Polycrystalline alumina with metal slot
 Monocrystalline alumina
61

Problems with Ceramic Brackets
 Fracture of bracket
 Friction within bracket slot
 Attrition on teeth contacting the bracket
 That’s why mostly placed on upper teeth
only.
 Enamel damage on bracket removal
 Chemical bonding which is strong,
mechanical bonding difficult in ceramic
bracket.
 Brittle, that’s why they are made bulky
and act as wide bracket. (effects of wide
bracket learnt in 9th chapter)
62

Straight Wire Concept in Bracket
63

 Compensation for 1st order
bends;
 For anterior teeth and premolars,
changing the bracket thickness
eliminate in – out bends in
anterior portion of arch wire. But
molar tube on molar bend should
be offset position to prevent
molar rotation.
64

 Because for good occlusion, the buccal surface of
molar must sit at an angle to line of occlusion.
 Mesio buccal cusp more prominent
 That’s why the tube on the molar band should be
at least 10 degree offset for maxillary molar.
 On mandibular molar it should be 5 – 7 degrees.
65

 A distal inclination or tip of the maxillary first
molar is important for proper posterior
occlusal interdigitating. If the mesiobuccal
cusp occludes in the mesial groove of the
mandibular first molar, creating an
apparently ideal Class I relationship, proper
interdigitating of the premolars still cannot
be obtained if the molar is positioned too
upright
 Tipping the molar distally allows the
premolars to interdigitate properly 4/4/2017DR. SARANG - S - HOTCHANDANI
66

Self Ligating Brackets
 In this ligatures are not
needed for holding wire,
but the mechanism for
retention of wire is built
within the brackets.
 Types of self – ligating brackets;
 Springy latching cap
 Smart clip system
 Springy retaining clips
 Innovation system
 Speed system
 Rigid latching caps
 Damon system
67

Archwires
68

Orthodontic Archwires
 During initial alignment phase;
 NiTi wire
 Stainless steel wire
 Coaxial wire
 To complete the process of levelling, beginning of overbite reduction, sliding of teeth along arch
wire;
 Round Stainless steel wire
 Arch wires during the later stages of overbite reduction and for space closure;
 Rectangular stainless steel wire
69

 NiTi wire is ideal for aligning teeth during initial stages of Tx.
 However, for later stages, space closure & overbite reduction, NiTi cannot
be used.
 In the initial stages of treatment, a wire which is flexible with good
resistance to permanent deformation is desirable, so that displaced
teeth can be aligned without the application of excessive forces.
70

 Initial Alignment (minimum stiffness, maximum range)
 Ni-Ti wire
 Multi-stranded wires
 Mid Treatment
 (Series of working wires with increasing stiffness and reduced range)
 Finishing & Detailing
 (Maximum Stiffness, snuggly fit rectangular wire)
71

Auxiliaries
72

Auxiliaries
 They are used to apply active forces for
space opening or closure.
 Elastic materials can be used for intra-arch
(intra-maxillary) space closure, and springs
constructed from stainless steel or nickel
titanium can be used for space opening.
 Types of Auxiliaries;
Elastic bands
Wire ligatures
Intra oral elastics
Palatal or lingual arches
Coiled springs
Power chains
73

Problems with Fixed Appliances
 Pain
 Tooth mobility
 Mucosal trauma
 Orthodontic wax can be used to cushion the wire
 Bracket failure
74

Temporary
Anchorage
Devices
• BONE SCREWS
• MINIPLATES
75

Indications of bone screws
 Positioning of individual teeth:
 Missing teeth – lack of anchorage
 Impacted teeth
 Position of groups of teeth;
 Space closure
 Major incisor retraction
 Incisor retraction & intrusion
 Mesial movement
 Maxillary & mandibular posterior teeth
 Entire mandibular arch
 Intrusion of anterior or posterior but not both simultaneously
76

Indications of miniplates
 Positioning groups of teeth.
 Distalization of entire maxillary & mandibular arch.
 Intrusion of anterior & posterior teeth
 Growth modification.
 Class III elastics, maxillary deficient child.
 Restriction of vertical maxillary growth.
77

References
 Cobourne, M. T. (2010). Handbook of Orthodontics. Mosby Elsevier.
 Gill, D. (n.d.). Orthodontics at a Glance 1st Edition. Blackwell.
 Mitchell, L. (n.d.). Introduction to Orthodontics 4th Edition. Oxford.
 Proffit, W. R. (n.d.). Contemporary Orthodontics 5th Edition. Elsevier.
78

“
”
THE END
DR. SARANG SURESH HOTCHANDANI
BDS
Bibi Aseefa Dental College, SMBBMU.
Larkana, Sindh, Pakistan
Email:
hotchandanisarang@gmail.com
Slideshare:
http://www.slideshare.net/sarangsureshhotchandani
Twitter:
https://twitter.com/fetusdentista 4/4/2017DR. SARANG - S - HOTCHANDANI
79

Fixed Orthodontic Appliance (Dentistry) #Braces

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