invisalign and laser and ancorage

laser

Invisalign
TAD

Laser in Orthodontics

The word LASER is an acronym for Light Amplification by Stimulated Emission of Radiation.
Light is an electromagnetic wave
Laser is an electromagnetic wave of certain characteristics
Characteristics of Laser: Directionality Monochromaticity (it is of one wavelength) Coherence (In phase in space in time) Brightness

All Laser devices should have the same basic components: A Laser medium. An optical cavity. A source of energy.
M2
M1
Source of energy
Energy out
Mechanical structure
Laser medium
Axis of propagation of Laser beam
Axis of mirrors
L

According to the State of Active Medium

1. Solid state Laser (Ruby, Nd.YAG, Nd.Glass). 2. Gas state Laser (Co2 laser, He-Ne laser). 3. Liquid state Laser (Dye Laser).
According to Operation Modes
1. Continuos wave (CW). 2. Pulse wave (PW).


The theoretical benefits of dental Lasers have been know almost from the time Laser were developed.
Pain-free procedures (sealing of near fiber) Elimination of cross-contamination (dry operating filed) Micro-surgery No blood (seal blood vessels) Elimination of sutures and minimize scarring. Faster healing (seal lymphatic vessels and this lead to minimal post operative swelling) reducing operative time.

1. Portability. 2. A light, low mass hand piece. 3. A controlled, well - focused beam. 4. Should be time -and coast- efficient. 5. The system must be readily sterilized. 6. Clearly, for the purchase.


Hard Tissue Procedures: Selective caries removal Cavity preparation Enamel etching Soft Tissue Procedures: Gingivectomy Frenectomy Root canal disinfection Crown lengthening Periodontal procedures Preprosthetic surgery Relieved the pain of aphthous ulcers
Low Power Therapy: Wound healing Bone regeneration Laser Diagnostics: Caries detection Lasers and Materials: Tooth Whitening Composite curring Laser sealing Lasers in Implantology: Bone preparation Bone regeneration Expose dental implants

1-lasers can help orthodontic patients to feel more comfortable when they have a canker sore or other ulceration adjacent to their braces. By keeping the laser at a distance from the lesion, the energy is absorbed but the tissue is not cut. The effect is that the sore is desensitized and healing is accelerated. 2-Orthodontist should use a laser in the removal of naturally structures that affect the position of your teeth and gums. This procedure is known as a frenectomy. (Muscle attachments known as frenam are found between the lips and gums. Some are too long and extend between the teeth creating spaces or recession. Lasers can be used to shorten these attachments to allow space closure). 3-lasers removal of swollen tissue. This extra tissue develops as a consequence of poor oral hygiene. it is grows over the enamel and makes future plaque removal even more difficult. Your orthodontist can remove swollen gums allowing better access to the underlying enamel.

4- It is gingival contouring (reshaping) to improve the esthetic appearance of the anterior teeth. . An orthodontist can quickly improve the appearance of your smile by using his laser .5- There are many times when the surface of the tooth is either fully or partially covered with gum tissue. This may be because the tooth is impacted, or it may be because the tooth just hasn’t come in all the way. using a laser to remove tissue so that a bracket can be placed early can save six months to a year of waiting. That can substantially shorten your treatment.

Invisible or invisaligne

In the world of cosmetic dentistry, there is a new orthodontic treatment system. It is a way to straighten teeth without metal braces


3D Computer Stimulation
This system creates custom-fitted aligners (clear) on the basis of 3-D computer imaging technology. To produce series of clear , custom made aligners that gradually moves the teeth. These aligners will slowly put teeth in the desired position within a period of 9-15 months.

Impressions of teeth are taken

Once set, the impression trays are Removed carefully
http://wimpoledental.co.uk/invisalign-london.php

The impressions are used to create a digital model of your teeth

The Invisalign software plans , the movement of teeth from their current position to the final desired position
http://wimpoledental.co.uk/invisalign-london.php

A series of nearly invisible aligners are custom made

The aligners follow the stages of the treatment plan

Place the aligners over teeth, where they fit snugly

Every 2 weeks switch to the next set of aligners
http://wimpoledental.co.uk/invisalign-london.php

Each aligner moves your teeth stage by stage slowly

http://wimpoledental.co.uk/invisalign-london.php

How often must wear the invisalign

Alingers must be wear day and night for 22 hrs . Except when eating , brushing or flossing. May temporary effect speech till patient adjusts

Indication of Invisalign

1-Designed especially for adults do not prefer wearing metal braces or those patient who hesitant to wear metal brace. 2- those patient how are allergic to metal. 3- those patient with long bridge or many prosthetic crowns .

ADVANTAGES and DISADVANTAGES of INVISALIGN

Advantages of Invisalign

1-It is removable in comparison to fix metal brace ,SO it is Comfortable and Better oral hygiene. 2- There is no Need to worry about the breaking or debonding of molar tube and brackets. 3-no requirement to visit the dentist frequently to activate the appliance. 4- In comparison to traditional braces, the transparent color of Invisalign aligners will make it hardly noticeable.

Disadvantages

1-People having sensitive gums will experience discomfort at the time of wearing Invisalign ,But this discomfort will be temporary. 2- use only with cooprative patient , because it is removable appliance 3- use only with mild to moderate malocclusion.

4-Breakage

Due to grinding of teeth, patients may break the aligners at some instances. Also, constant removal of aligners may put the same at a risk of getting damaged and broken..

Question Why it is not widely use in our country

Temporary AnchorageDevices in Orthodontics (TAD) or mini-screw Implant

TAD

A TAD can be defined as a device that is temporarily fixed to the bone for the purpose of enhancing orthodontic anchorage either by supporting the teeth of the reactive unit (indirect anchorage) or by obviating the need for the reactive unit altogether (Direct anchorage), which is subsequently removed after use.



Anchorage
Anchorage is defined as the resistance to unwanted tooth movement.However, because of Newton’s third law, i.e., for every action there is an equal and opposite reaction

Traditionally, orthodontists used teeth, intraoral appliances, and extraoral appliances, to control anchorage to minimizing the movement of certain teeth, while completing the desired movement of other teeth.

Use of extraoral anchorage devices such as headgears requires full patient cooperation, which is sometimes not possible and is unpredictable. While problems with dental anchors are that, the anchor units experience a reciprocal effect of the forces applied to move the remaining teeth to their optimal positions – thereby tending to move towards the direction of the force applied Disadvantage of traditional anchorage


PARTS OF IMPLANT The commonly used implant screw/plate has two parts Implant head Implant body
Introduction of implants in orthodontics have solved this problem


TAD

IMPLANT DRIVING METHOD

Self Drilling: Here, the miniscrew is driven directly into bone without drilling. This method can be used when we want to use larger diameter (more than 1.5 mm) miniscrews. It does not require a pilot hole. It has either a sharp or a tapered apex to allow placement or a notch in the tip to drill through the cortex.

Self tapping : These screws are unable to create their own thread as the advance in the bone the miniscrew is driven into the tunnel of bone formed by drilling, making it tap during implant driving. This method is used when we use small diameter miniscrews.
IMPLANT DRIVING METHOD

For proper position : 5 mm from CEJ and x-ray .

Materials used
The material must be nontoxic and biocompatible, have favorable mechanical properties, and be able to resist stress and strain Conventional implants are made up of pure titanium or titanium alloy or titanium coated stainless steel.

based on the site of placement: Buccal Palatal Based on technique of placement: Self drilling Tapping Based on shape: Cylindrical Tapered Combinition
Classification of Microimplants


based on the size:Length 4-12 mm (small, medium, large) Diameter 1.15 – 2.5 mm (small, medium, large) based on head type: Small Long Circle Bracket Hook

Indication of TAD Moderate to maximum anchorage Mild to moderate anchorage need when the anchor unit is limited by an inadequate number of anchor teeth (e.g early tooth loss or hypodontia).

contraindications: When other conventional methods of anchorage are adequate. Poor Oral hygiene Smoking Local Bone pathology Inadequate bone depth and quality Local factors like bone amount and local infection

Difference between traditional anchorage and TAD anchorage

Orthodontic anchorage using TAD
Traditional Orthodontic anchorage
Character
Implant or micro-implant
Teeth and extraoral bony structure
Anchorage source
Position is stable during treatment
Position of anchor teeth is not stable during treatment
Stability of anchorage
For direct anchorage teeth are not necessary , while for indirect anchorage minimum number of teeth are need
Maximum number of teeth must be included
Number of Anchor teeth
More efficient as force is transmitted directly to the implat
Apply force on teeth part of it is wasted due to periodontal amortization
Treatment Efficiency
Shortened treatment time
Treatment time prolonged
Duration of treatment
Minimal
Obligatory
Patient cooperative
Discomfort for the patient is minimal
Most of the treatment device restricted motion, also do not meet esthetic requirement
Treatment acceptability

Dr. Hakam