FIXED ORTHODONTIC APPLIANCES

DENT 657

Removable vs. Fixed Appliances

REMOVABLE Tipping only No control over root

movement Pt’s co-operation Hygienic

FIXED Bodily translation Control of root

movement Less dependent on pt’s

co-op Less hygienic

DEVELOPMENT OF FIXED ORTHODONTIC APPLIANCES

Development of Fixed appliances

Early fixed appliances Late 1800s Edward Angle

EARLY FIXED APPLIANCES

Development of Fixed appliances

Standard Edgewise appliance Early 1900s

Development of Fixed appliances

Pre-adjusted edgewise appliance 1970s Refined manufacturing process with “built-

in” adjustments specific for each tooth Advances in material sciences made

attachment much smaller

BANDED APPLIANCES

Bonding to Enamel

Bonding Surface - Bracket Base

BONDED APPLIANCES

Lingual Appliance

CERAMIC APPLIANCES

Self Ligating Appliance

PASSIVE FIXED APPLIANCES

Components of the Fixed Appliance Bands Molar Tubes Brackets Buccal Tubes Arch Wires Auxiliaries: Elastomeric products, Coil

springs, Lingual arches, Extra-oral appliances

Posterior attachments

MOLAR TUBES

Components of the Fixed Appliance Bands Molar Tubes Brackets Arch Wires Auxiliaries: Elastomeric products, Coil

springs, Lingual arches, Extra-oral appliances

Anterior Attachments

Brackets

Components of the Fixed Appliance Bands Molar Tubes Brackets Arch Wires Auxiliaries: Elastomeric products, Coil

springs, Lingual arches, Extra-oral appliances

ARCH WIRES

Maxillary and mandibular Arch form described as “parabolic shaped” Size and cross-section of wires vary Material varies eg. Nickel Titanium alloy

(NiTi), Titanium Molybdenum Alloy (TMA), Stainless Steel

Components of the Fixed Appliance Bands Molar Tubes Brackets Arch Wires Auxiliaries: Elastomeric products, Coil

springs, Lingual arches, Extra-oral appliances

Elastics

EXTRA ORAL FORCES - HEAD GEAR

Coil Spring

Closed or open coil springs

Pre-Adjusted Edgewise Appliance or The Straight Wire Appliance

Larry Andrews - studied normal occlusion and individual tooth positions

Developed prescriptions for individual tooth position

Elements of “ideal” tooth position are built into the appliance

Minimizing active “wire manipulation” - The Straight Wire Concept

Pre-adjusted edgewise appliance

First order / in-out - Horizontal plane Second order / tip - Mesio-distal angulation Third order / torque - Labio-lingual

angulation

3 - Dimensional control of tooth position

First order or In-out

Pre-adjusted edgewise appliance

First order / in-out - Horizontal plane Second order / tip - Mesio-distal angulation Third order / torque - Labio-lingual

angulation

Second order or Tip

4

Pre-adjusted edgewise appliance

First order / in-out - Horizontal plane Second order / tip - Mesio-distal angulation Third order / torque - Labio-lingual

angulation

Third order or Torque

4

To “Torque” is the least efficienttooth movement using orthodonticappliances

Significance of accurate bracket/band positioning

Precise tooth positioning Optimal effect of “pre-adjustment” Occlusion Esthetics Stability

POSITIONING BRACKETS - GENERAL INSTRUCTIONS

Rhomboidal shapeDisto-lingual wing markCentral scribe line (long axis)

Maxillary Central Incisors

4

Distance from the slot to theincisal edge = 4mm

From the occlusal, the bracketis centered mesio-distally.

As a guide, approximate theincisal edge of the incisor withthe base of the bracketperpendicular to the clinicalcrown long axis.

4

Maxillary Lateral Incisor

3.5

Distance from the slot to the incisal edge= 3.5mm

3.5

Maxillary Cuspids

4.5

4.5 mm

Distance from cusp tip to bracket slot =4.5 mm

The severe angulation and prominentanatomy of cuspids (10o) can makeplacement difficult

From the occlusal view, the bracket iscentered mesio-distally on the prominentbuccal developmental ridge. This alsocorresponds to the clinical crown longaxis. This will usually be mesial to thecenter of the contacts

Maxillary Bicuspids

Distance from cusp tip to bracket slot =4 mm

From the occlusal view, the bracket iscentered mesio-distally on the prominentbuccal developmental ridge. This alsocorresponds to the clinical crown longaxis.

Mandibular Incisors

Mandibular Cuspid

Mandibular Bicuspids

Maxillary first molar bands

Mandibular first molar bands

Palmer notation used in Orthodontics

Right Left

Upper 7 6 5 4 3 2 1 1 2 3 4 5 6 7 UpperTooth # 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Tooth # 31 30 29 28 27 26 25 24 23 22 21 20 19 18

Lower 7 6 5 4 3 2 1 1 2 3 4 5 6 7 Lower

The bracket height chart is written in Palmer Notation. This notation numbers the teeth startingwith the central incisors as 1. The laterals are then 2. The canines are 3. The 1st and 2nd

premolars are 4 and 5 respectively, the 1st molars are 6 and the 2nd molars are 7.

Bracket Heights from Cusp tip or Incisal Edge

Right 2nd

M1st

M2nd

B1st

BCu LI CI CI LI Cu 1st

B2nd

B1st

M2nd

MLeft

Upper 7 6 5 4 3 2 1 1 2 3 4 5 6 7 Upper

Bracketheight

3.54 4 4

4.5

3.54 4

3.5

4.54 4 4

3.5

In mm

Occplane

Bracketheight

3.54 4 4

4.54 4 4 4

4.54 4 4

3.5 In mm

Lower 7 6 5 4 3 2 1 1 2 3 4 5 6 7 Lower