fixed appliance pptx - د.أسيل

Component of the Fixed Appliance

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introduction

Fixed Orthodontic Appliance

• Bonded (fixed) appliance Apparatus that remains firmly in place, not intended to be removed by the patient, to achieve alignment of upper or lower teeth for the correction of malocclusions .
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Indications of fixed orthodontic appliance
When multiple tooth movement is required.
Intrusion
Derotation
Controlled space closure at extraction sites.
Bodily movement
Extrusion
Torque control

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Poorly motivated patient
Poor dental health
Extremely sever malocclusion requiring orthognathic surgery
Contraindications of fixed appliance
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Component of fixed orthodontic Applince

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Component of fixed orthodontic Applince

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Component of fixed orthodontic Applince can be devided into :

1- Fixed components
2- removable component
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BANDS

Fixed Component: Bands

Metal attachments that are cemented to individual teeth and provide a place for attachment of other auxiliaries like buccal tubes, lingual buttons, etc.
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Types

Pinched Bands: they are formed on tooth surface, welded electrically and to them attachments are welded.
Preformed Bands: they are prefabricated.
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the zinc phosphate.

glass ionomer cements.

New cements: a composite of glass ionomer and resin materials, and usually are light-cured.

All interior surfaces of an orthodontic band must be coated with cement before it is placed, so that there is no bare metal.
Cementation
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Bounded Base

a- Principle Attachment include Bracket and
edge wise tube

b- Accessory Attachment include Tube, Hook , Buttons & Cleat , and Eye Let.

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BRACKET

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1. Material used:

• Metal brackets:
• stainless steel brackets
• Nickel titanium brackets
• gold brackets
• Plastic
• Polycarbonate
• Fiberglass reinforced plastic
• Polyurethane
Classification of Brackets
• Ceramic
• Alumina based:
• Monocrystalline
• Polycrystalline
• Laminated brackets.
• 2. Zirconia based brackets
Brackets can be classified according to:
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Brackets type

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2- Brackets according to type of ligation

Brackets with ligation
Self-ligating brackets:
• Passif
• active

parts of bracket

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Bracket Part of Bracket

Base : it content welded mesh or other retentive structure to increase the bonding strength.
Slot : horizontal canal that receive the arch wire, its size and shape vary with orthodontic technique and type of appliance .
Wings: projection from the centre of the bracket to facility retention of the ligature wire or elastic to secure the arch wire in place
Hook: prewelded of soldered to the distogingival wing of the bracket to facility elastic attachment

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3. Slot Size and shape
• Measurements
• Vertical depth: 0.018 or 0.022”
• Horizontal depth: 0.025 or 0.028 or 0.030”

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- Vertical rounded slot (Begg)

- Horizontal rectangular slot (edgewise) by Angle
- Combination
- Horizontal square slot (Rickett)…0.018 * 0.018
Slot Shape

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• Siamese.
• Mini-twin.
• Single wing.
• Self-ligating.
4. Morphology of the Bracket

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5. According to No. of wing
Single : 2 Wings
Twin : 4 Wings
Triple : 6 Wings
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6. According to Design

- Standard Bracket : the Bracket base with uniform thickness and the slot with zero torque and zero angulation
- Preadjusted bracket by Varing

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Orthodontic tubes

Bondable Tube

Tube parts

Orthodontic tubes

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Bondable bottons

Removable Component Archwires

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1- Material
stainless steel, Elgiloy, titanium alloys, glass, polymers , coated with metal or non-coated

2- Cross Section

round, rectangular, single, multistrand or braided

Classification of archwire acording to:

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archwires

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Classification of archwire acording to:
• 3- Size
• Round
• Rectangular
• Square
• 0.012 inch (0.30 mm)
• 0.16 x 0.022 inch
• (0.41 x 0.56 mm)
• 0.016 x 0.016 inch
• (0.41 x 0.41 mm)
• 0.014 inch (0.35 mm)
• 0.17 x 0.022 inch
• (0.43 x 0.56 mm)
• 0.017 x 0.017 inch
• (0.43 x 0.43 mm)
• 0.016 inch (0.40 mm)
• 0.17 x 0.025 inch
• (0.43 x 0.64 mm)
• 0.018 x 0.018 inch
• (0.46 x 0.46 mm)
• 0.017 inch (0.43 mm)
• 0.18 x 0.025 inch
• (0.46 x 0.64 mm)
• 0.019 x 0.019 inch
• (0.48 x 0.48 mm)
• 0.018 inch (0.46 mm)
• 0.19 x 0.025 inch
• (0.48 x 0.64 mm)
• 0.019 inch (0.48 mm)
• 0.20 x 0.025 inch
• (0.51 x 0.64 mm)
• 0.020 inch (0.51 mm)
• 0.21 x 0.025 inch
• (0.53 x 0.64 mm)
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Archwire
A wire engaged in orthodontic attachments that are affixed to the crowns of two or more teeth to cause or guide tooth movement .

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• high strength.
• low stiffness.
• high range.
• high formability.
• Weldable
• Aesthetics
• biocompatible
Properties of an ideal orthodontic archwire

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Ligation of archwire
• ligation of A.W.:
• steel ligature
• steel kobayshi ligature
• elastomeric ligature
• self-ligation

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Techniques of ligation

Fig 1. Diagram of basic ties for upper canines:

metal ligatures in straight (A) and double-over (B) ties;
elastic ligatures in straight (C) and double-over (D) ties.
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Techniques of ligation

Fig 2. Ligature must be snug with bracket to prevent slackening. Diagram shows correct ligature position from labial (A) and occlusal (B) perspectives;
wrong ligature position is shown from labial (C) and occlusal (D) perspectives
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Techniques of ligation
Fig 3. Ligature wire makes a loop around the rotated tooth so that when the wire is twisted, the part of the tooth farther from the alignment is pulled toward the archwire, labial (A) and occlusal (B) perspectives.
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Techniques of ligation

Fig 9. In cases where segmented round archwires are used, a stabilization tie may be useful to prevent the wire
rotating in the bracket slots. In the detail, the loop around the vertical bend is incorporated into the archwire.
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Techniques of ligation

Fig 11. Tie togethers can be used to support the archwire (A and B) or not (C and D), being crosstied in the interbracket area (A and C) or twisted (B and D). Additional ligatures must be used when the archwire is not supported by the tie together (C and D).
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• Begg light wire appliance.

• Edge-wise appliance.
• Straight wire appliance.
• Tip-edge appliance.
• Lingual pre-adjusted edgewise appliance.
Fixed orthodontic systems
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• Seperation.
• Fitting Bands.
• Cementation.
Steps in Banding

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Separators Types
It create space among teeth to be banded to be banded for easy placement of orthodontic band, it needs 2-5 days .
* Metal : soft SS (0.5mm) .* Electrometric(blue for post.& green for ant.).* Spring .

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Seperation
Separating springs, typically opening enough space for banding in approximately 1 week.
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Separating Springs

Elastomeric separators ("doughnuts"), squeeze the teeth apart over a period of several days.
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Headgear Tubes.

Auxiliary Edgewise tubes.

Auxiliary Labial Hooks.

Lingual Arch Attachments.

Lingual Attachments, (buttons, cleats and eyelets).

Uprighting Springs.
Auxiliary Elements

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Headgear Tubes

45 or 51 mil round tubes are placed on maxillary first molars > to insert the inner bow of the face bow appliance.
Also can accept a heavy auxiliary labial arch wire.
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Auxiliary Edgewise tubes

Used mainly for segmented arch technique, which are necessary to intrude teeth.

Placed gingivaly in relation to the main arch wire on both maxillary and mandibular first molars.
Auxiliary rectangular tubes on canines are also used during space closure of the extraction spaces.
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Lingual Arch Attachments

• There are two lingual attachments:
• One is the horizontal lingual sheath which made to accept a doubled-over segment of 36 or 30 mil steel wire.
• The other is a lingual bracket made to accept 32 × 32 beta-titanium or steel wire.
• Uses:
• Stabilize lingual arch.
• Reinforce the anchorage and tooth movement.

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Lingual Attachments
buttons, cleats and eyelets.
Used for attachment of cross-elastics.
Used to control rotations of premolars and canines during space closure.

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Uprighting Springs

Made of 0.012’’ or 0.014’’ Australian wire.

They move the tooth root in a mesial or distal direction.
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Bracket Placement
Mesiodistal Bracket positioning on flat surfaces teeth . It’s important to position brackets in the mesiodistal centers, while on cuspids and bicuspids it’s important to position the bracket at the crest of the contour on their buccal surfaces. The other authors used following scheme to determine the vertical bracket position
• Maxillary teeth
• Vertical measurement
• Mandibular teeth
• Vertical measurement
• Central incisors
• 4.0 mm
• Central incisors
• 3.5 mm
• Lateral incisors
• 3.5 mm
• Lateral incisors
• 3.5 mm
• Canines
• 4.5 mm
• Canines
• 4.5 mm
• Premolars and Molars
• 4.0 mm
• Premolars and Molars
• 4.0 mm
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A. Brass wire.
A stop, hook or loop, soldered, crimped or bent into an archwire, usually at some point anterior to the molar tubes, so that the archwire can be tied to the molar attachments by means of stainless steel or elastic ligature.
B. Sliding Jig.
used for application of an intermaxillary force to an individual tooth as in retraction of anterior teeth for space closure.
C. Auxiliary Forces Elements:
1. intra max. forces.
2. inter max. forces.
3. extra oral forces.
Accessory Components
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Sliding jigs

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• I. Intra max. forces:

• between 2 teeth or 2 groups of teeth in the
• same dental arches

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• 1. elastic ligature

especially delicate plastic ligatures
for ligating arch wires to the brackets

Intra max. forces

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• Uses :

• 1- Space closure
• 2- Rotational correction
• 3- Space consolidation
• 4- pulling ectopic tooth into
• arch wire
2-Power Chain Elastic
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3. elastomeric thread :

used for:
rotation
Cusped movement
figure eight ligation,etc.

-Elastic ligature silk

spun elastic thread of
medium force

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Function
It create space among teeth to be banded for easy placement of orthodontic band, it needs 2-5 days
4-Separators

• Types

• Metal : soft SS (0.5 mm).
• Elastomeric
• Spring
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5. Rubber bands

used as intraoral &extraoral
elastics

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6- Stainless steel open &close coil springs.

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• 2. Inter max. forces:
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Component of CL-II elastics:

1. Anterior-posterior component: distal force to the maxillary teeth & mesial force to the mandibular teeth which result in retraction of maxillary teeth & protraction of mandibular teeth.

2. Vertical component; extrusion of maxillary anterior teeth & mandibular posterior teeth which result in rotation of the occlusal plane up posteriorly & down anteriorly.

3. Transverse component (slight force); buccal tipping of the lower molars.

A. CL-II elastic

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Extra oral force appliances:
Headgear + Face bow
• It can be used with maxillary fixed or removable appliance.
• Fixed appliance can be simple as banded maxillary 1st permanent molars alone.
• Include banding as bonding of remaining dentition.
Neckgear + Face bow
Directional Force ( J-hooks )
• Attach directly to the anterior part of the upper arch wire.
• Lit is used more commonly for retraction of canines or incisors.
Reverse Facial mask
it is made of two pads that contact the soft tissue in the forehead and chin region, the connect by midline framework and adjustable by set screw.
headgear + chin cup
Indicate at class III malocclusion
Auxiliary force elements

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TYPES OF ANCHORAGE FOR HEADGEAR:
• 1. Cervical attachment (neck strap);
• 2. Occipital attachment or headcap
• 3. Combination of headgear (cervical & occipital attachment)