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FIXED
ORTHODONTICS
Dr Zahra Khalid
DEVELOPMENT OF
ORTHODONTIC
APPLIANCES
E ARCH
 Basic design : Had rigid framework
to which teeth has been tied so that
they could be expanded to arch form
dictated by the appliance
 Bands were placed only on molar
teeth and a heavy labial archwire
extended around the arch
 End of the wire was threaded and a
small nut placed on the threaded
portion of the arch allowed archwire
to be advanced so that arch
perimeter increased
PIN AND TUBE APPLIANCE
 First appliance that employed a
bracket and used bands on most
of the teeth
 Angle placed bands on other
teeth apart from molars and used
a vertical tube on each tooth into
which a soldered pin from a
smaller archwire was placed
 Tooth movement was
accomplished by repositioning the
individual pins at each
appointment
RIBBON ARCH APPLIANCE
 Angle modified the tube on each tooth to provide
a vertically positioned rectangular slot behind the
tube
 A ribbon arch of 10 X 20 gold wire was placed
into the slot and held with pins
 Was an immediate success primarily because the
archwire was small enough to have good spring
qualities and was quite efficient in aligning
malposed teeth
 Poor control of root position
BEGGS APPLIANCE
 Begg’s adaptation took three forms
 He replaced the precious metal ribbon arch with
high strength 16 mil stainless steel wire ( 1930 )
 He retained the original ribbon arch bracket but
turned it upside down so that the bracket slot
pointed gingivally rather than occlusally
 He added auxiliary springs appliance for control
of root position
EDGEWISE APPLIANCE
 Angle re oriented the slot from vertical to
horizontal and inserted a rectangular wire rotated
90 degrees to the orientation it had with the ribbon
arch
 Dimensions of the slot were altered to 22 x 28
mils and a 22 x 28 precious metal wire was used
 These dimensions arrived after excessive
experimentation did not allow excellent control of
crown and root position in all three planes of
space
 Rectangular brackets with gingival and
occlusal wings were soldered to bands
 This appliance soon became the most popular
appliance in the U.S., as it was the first to
move teeth in all three planes of space
simultaneously,
PREADJUSTED EDGEWISE/
STRAIGHTWIRE APPLIANCE
 From his extensive measurements, Andrews
determined the average tip and torque angles and
in/out dimensions of the labial surface of each tooth
relative to a flat labial arch wire plane, coined the
“Andrews’ Plane”
 When each pre adjusted bracket was precisely
positioned at the midpoint of each tooth’s facial axis,
the brackets formed the Straight-Wire Appliance
 He also developed a series of extraction brackets
which include anti-tip and anti rotation components not
found in the Standard SWA prescription
CONTEMPORARY EDGEWISE
 https://youtu.be/q6TxmzNFcXQ
 https://youtu.be/6ixDYdcccEI
 https://www.youtube.com/watch?v=2IEISXeN
D1E
MATERIALS FOR BANDING
 Glass ionomer cement
 Zinc phosphate
 https://youtu.be/hwHcSGo40ng
BASIS OF BONDING
MATERIALS FOR BONDING
 Dimensionally stable
 Fluid enough to penetrate the enamel surface
 Excellent inherent/bond strength
 Self/Light activated (bis-GMA) resins
 Self adhesive resin cements(with self etch
primer or self adhesive component)
 Modified GIC(less strength but F release)
DIRECT BONDING
 Advantages
 Easier
 Faster
 Less expensive
 Disadvantages
 Less precise
INDIRECT BONDING
 Advantage
 Precise location of brackets is possible
 Disadvantages
 Expensive
 Laboratory involved
 https://youtu.be/K6h_vosBibw
 ee
DEBANDING/DEBONDING
Failure at 3 interfaces
Between the bracket base and
bonding material (preferred site)
Within the bonding material
itself
Between the bonding material
and enamel surface
DEBONDING CERAMIC
BRACKETS
 Thermal debonding
 Lasers
 Modifying bonding interface
TYPES OF BRACKETS
ACCORDING TO MATERIAL
 Metal brackets
 Esthetic brackets
 Plastic brackets
 Ceramic brackets
METAL BRACKETS
 Stainless steel
ADVANTAGES
 Dimensionally stable
 Resist staining
 Less friction
 Less expensive
DISADVANTAGES
 Unesthetic
 Tend to corrode
PLASTIC/POLYCARBONATE
BRACKETS
ADVANTAGES
 Available in tooth colored or transparent forms
DISADVANTAGES
 Staining and discoloration
 Poor dimensional stability
 Friction between plastic bracket and archwire
 Using a metal slot can solve the 2nd and 3rd
problems
CERAMIC BRACKETS
 Zirconia and alumina
 Monocrystalline or polycrystalline forms
ADVANTAGES
 More esthetic
 Dimensionally stable
 Resist staining
DISADVANTAGES
 Brittle/easily fractureds
 Loss of parts of brackets
 Cracking when torque forces are applied
 Increased friction(can be reduced by
incorporating a metal slot)
 Wear of opposing teeth
 Enamel damage during debonding
TYPES OF BRACKETS
 METAL
 Stainless steel
 Co Cr
 Titanium
 Gold
 CERAMIC
 PLASTIC
 LINGUAL
 SELF LIGATING
LINGUAL BRACKETS
MANUFACTURING
TECHNIQUES OF BRACKETS
 Casting
 Milling
 Metal/Ceramic/Plastic injection moulding
MIM
BRACKET PRESCRIPTION
ORTHODONTIC
ARCHWIRES
 Precious metal alloys
 Stainless steel and Cobalt-Chromium alloys
 Nickel Titanium alloys
 Beta Titanium
 Stiffness: Resistance to deformation
 Formability: Amount of permanent deformation
that a wire can withstand before failing
 Resilience: Energy storage capacity of wire,
combination of strength and springiness
 Range: Distance the wire behaves elastically
before it deforms
Strength= Stiffness x Range
STRESS/STRAIN OR LOAD DEFLECTION
CURVE
DESIRABLE PROPERTIES OF
AN ARCHWIRE
PRECIOUS METALS
 Used in the first half of twentieth century
 Gold alloy with platinum, palladium, copper were
used
 Advantages
• High ductility
• Inert nature and corrosion resistance - so did not
form toxic products with saliva
• Variable stiffness- by heat treatment
• High resilience
• Ease of soldering
 Disadvantages
 Elastic force delivery much less
 Greater cost compared to other base metal
wires
Have minimal use currently
STAINLESS STEEL
 A typical formulation for orthodontic use
is“18-8” SS, containing approximately 18%
chromium and 8% nickel. Also contains Fe,
and C
 The properties can be controlled by cold
working and annealing
Properties
 High stiffness
 Better strength
 Corrosion resistance
 Can be soldered and welded for the fabrication
of complex appliances
 Malleable and ductile
 Low springback
 Less surface friction
 Space closure favourable due to stiffness and
low surface friction
COBALT CHROMIUM
 Developed during the 1950s as Elgiloy
 Composition:
 Cobalt – 40-45% –
 Chromium – 15-22% –
 Nickel – for strength and ductility –
 Iron, molybdenum, tungsten and titanium to
form stable carbides and enhance hardenability.
NICKEL TITANIUM
 Useful during the initial orthodontic alignment.
 Ni 55%, Ti 45%
 Can apply a light force over a large range of
activations so used in Alignment and levelling
stage of treatment
 Nitinol (Ni, nickel; Ti, titanium; NOL, Naval
Ordnance Laboratory) – first Nickel Titanium alloy
developed for space program
 Shape memory
 Superelasticity
 Good springback
 More range
 More formability
 Martensite at low temperature and high
pressure/stress
Shape memory
 Ability of material to remember its original
shape after being plastically deformed while in
the martensitic form.Certain shape is set at an
elevated temperature , above martensite-
asutenite transition temperature. When the
alloy is cooled it can be transitionally
deformed Heated enough to regain the
austenitic structure Original shape is restored
 Thermal reaction
Superelasticity
 Reversible strain wire can withstand due to
martensite- austenitic phase transition
 Transition to martensitic in response to
stress./Mechanical reaction
BETA TITANIUM
 Properties inbetween SS and Ni Ti
 Called as Titanium Molybdenum alloy (TMA)
 Offers a highly desirable combination of
strength, springiness and formability.
 Modulus of elasticity less than SS but more
than Ni Ti
 Excellent choice for auxiliary springs and for
intermediate and finishing archwires
 Especially rectangular wires for the late
stages of edgewise treatment
ARCHWIRE SIZE AND
SHAPE
 Based on cross section
 Round
 Square
 Rectangular
 Multistranded
WIRE SIZE
 Specified in thousands of an inch
 Eg, .016 inch =16 mil
 16 mil → 16/4 = 04 → 0.4 mm
 40 mil → 40/4 = 10 → 1.0 mm
ARCH FORMS
 Round/Ovoid
 Square
 V shaped/Tapering
CATENARY CURVE
 Catenary Curve
 Premolar-canine-incisor segment of the arch
very nicely for most individuals
 For all patients, the fit is not as good
BRADER ARCHFORM
 Based on a trifocal ellipse.
 The anterior segment closely approximates
the anterior segment of a catenary curve
 Gradually constricts posteriorly
 More closely approximate the normal position
of the second and third molars

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Fixed Orthodontics

  • 2.
  • 4. E ARCH  Basic design : Had rigid framework to which teeth has been tied so that they could be expanded to arch form dictated by the appliance  Bands were placed only on molar teeth and a heavy labial archwire extended around the arch  End of the wire was threaded and a small nut placed on the threaded portion of the arch allowed archwire to be advanced so that arch perimeter increased
  • 5.
  • 6. PIN AND TUBE APPLIANCE  First appliance that employed a bracket and used bands on most of the teeth  Angle placed bands on other teeth apart from molars and used a vertical tube on each tooth into which a soldered pin from a smaller archwire was placed  Tooth movement was accomplished by repositioning the individual pins at each appointment
  • 7. RIBBON ARCH APPLIANCE  Angle modified the tube on each tooth to provide a vertically positioned rectangular slot behind the tube  A ribbon arch of 10 X 20 gold wire was placed into the slot and held with pins  Was an immediate success primarily because the archwire was small enough to have good spring qualities and was quite efficient in aligning malposed teeth  Poor control of root position
  • 8.
  • 9. BEGGS APPLIANCE  Begg’s adaptation took three forms  He replaced the precious metal ribbon arch with high strength 16 mil stainless steel wire ( 1930 )  He retained the original ribbon arch bracket but turned it upside down so that the bracket slot pointed gingivally rather than occlusally  He added auxiliary springs appliance for control of root position
  • 10.
  • 11.
  • 12. EDGEWISE APPLIANCE  Angle re oriented the slot from vertical to horizontal and inserted a rectangular wire rotated 90 degrees to the orientation it had with the ribbon arch  Dimensions of the slot were altered to 22 x 28 mils and a 22 x 28 precious metal wire was used  These dimensions arrived after excessive experimentation did not allow excellent control of crown and root position in all three planes of space
  • 13.  Rectangular brackets with gingival and occlusal wings were soldered to bands  This appliance soon became the most popular appliance in the U.S., as it was the first to move teeth in all three planes of space simultaneously,
  • 14.
  • 15.
  • 16. PREADJUSTED EDGEWISE/ STRAIGHTWIRE APPLIANCE  From his extensive measurements, Andrews determined the average tip and torque angles and in/out dimensions of the labial surface of each tooth relative to a flat labial arch wire plane, coined the “Andrews’ Plane”  When each pre adjusted bracket was precisely positioned at the midpoint of each tooth’s facial axis, the brackets formed the Straight-Wire Appliance  He also developed a series of extraction brackets which include anti-tip and anti rotation components not found in the Standard SWA prescription
  • 17.
  • 18.
  • 20.
  • 21.
  • 22.
  • 23.
  • 24.
  • 25.
  • 26.
  • 27.
  • 28.
  • 29.
  • 31.
  • 32.
  • 34.
  • 35.
  • 36.
  • 37. MATERIALS FOR BANDING  Glass ionomer cement  Zinc phosphate
  • 38.
  • 39.
  • 41.
  • 42.
  • 43.
  • 45. MATERIALS FOR BONDING  Dimensionally stable  Fluid enough to penetrate the enamel surface  Excellent inherent/bond strength
  • 46.  Self/Light activated (bis-GMA) resins  Self adhesive resin cements(with self etch primer or self adhesive component)  Modified GIC(less strength but F release)
  • 47.
  • 48. DIRECT BONDING  Advantages  Easier  Faster  Less expensive  Disadvantages  Less precise
  • 49.
  • 50.
  • 51. INDIRECT BONDING  Advantage  Precise location of brackets is possible  Disadvantages  Expensive  Laboratory involved
  • 52.
  • 53.
  • 56.
  • 57.
  • 58.
  • 59.
  • 60. Failure at 3 interfaces Between the bracket base and bonding material (preferred site) Within the bonding material itself Between the bonding material and enamel surface
  • 61.
  • 62. DEBONDING CERAMIC BRACKETS  Thermal debonding  Lasers  Modifying bonding interface
  • 63. TYPES OF BRACKETS ACCORDING TO MATERIAL  Metal brackets  Esthetic brackets  Plastic brackets  Ceramic brackets
  • 65. ADVANTAGES  Dimensionally stable  Resist staining  Less friction  Less expensive
  • 68. ADVANTAGES  Available in tooth colored or transparent forms
  • 69. DISADVANTAGES  Staining and discoloration  Poor dimensional stability  Friction between plastic bracket and archwire  Using a metal slot can solve the 2nd and 3rd problems
  • 70. CERAMIC BRACKETS  Zirconia and alumina  Monocrystalline or polycrystalline forms
  • 71. ADVANTAGES  More esthetic  Dimensionally stable  Resist staining
  • 72. DISADVANTAGES  Brittle/easily fractureds  Loss of parts of brackets  Cracking when torque forces are applied  Increased friction(can be reduced by incorporating a metal slot)  Wear of opposing teeth  Enamel damage during debonding
  • 73. TYPES OF BRACKETS  METAL  Stainless steel  Co Cr  Titanium  Gold  CERAMIC  PLASTIC  LINGUAL  SELF LIGATING
  • 75.
  • 76. MANUFACTURING TECHNIQUES OF BRACKETS  Casting  Milling  Metal/Ceramic/Plastic injection moulding
  • 77. MIM
  • 78.
  • 80. ORTHODONTIC ARCHWIRES  Precious metal alloys  Stainless steel and Cobalt-Chromium alloys  Nickel Titanium alloys  Beta Titanium
  • 81.  Stiffness: Resistance to deformation  Formability: Amount of permanent deformation that a wire can withstand before failing  Resilience: Energy storage capacity of wire, combination of strength and springiness  Range: Distance the wire behaves elastically before it deforms Strength= Stiffness x Range
  • 82. STRESS/STRAIN OR LOAD DEFLECTION CURVE
  • 84. PRECIOUS METALS  Used in the first half of twentieth century  Gold alloy with platinum, palladium, copper were used  Advantages • High ductility • Inert nature and corrosion resistance - so did not form toxic products with saliva • Variable stiffness- by heat treatment • High resilience • Ease of soldering
  • 85.  Disadvantages  Elastic force delivery much less  Greater cost compared to other base metal wires Have minimal use currently
  • 86. STAINLESS STEEL  A typical formulation for orthodontic use is“18-8” SS, containing approximately 18% chromium and 8% nickel. Also contains Fe, and C  The properties can be controlled by cold working and annealing
  • 87. Properties  High stiffness  Better strength  Corrosion resistance  Can be soldered and welded for the fabrication of complex appliances  Malleable and ductile  Low springback  Less surface friction  Space closure favourable due to stiffness and low surface friction
  • 88. COBALT CHROMIUM  Developed during the 1950s as Elgiloy  Composition:  Cobalt – 40-45% –  Chromium – 15-22% –  Nickel – for strength and ductility –  Iron, molybdenum, tungsten and titanium to form stable carbides and enhance hardenability.
  • 89. NICKEL TITANIUM  Useful during the initial orthodontic alignment.  Ni 55%, Ti 45%  Can apply a light force over a large range of activations so used in Alignment and levelling stage of treatment  Nitinol (Ni, nickel; Ti, titanium; NOL, Naval Ordnance Laboratory) – first Nickel Titanium alloy developed for space program
  • 90.  Shape memory  Superelasticity  Good springback  More range  More formability  Martensite at low temperature and high pressure/stress
  • 91. Shape memory  Ability of material to remember its original shape after being plastically deformed while in the martensitic form.Certain shape is set at an elevated temperature , above martensite- asutenite transition temperature. When the alloy is cooled it can be transitionally deformed Heated enough to regain the austenitic structure Original shape is restored  Thermal reaction
  • 92. Superelasticity  Reversible strain wire can withstand due to martensite- austenitic phase transition  Transition to martensitic in response to stress./Mechanical reaction
  • 93.
  • 94.
  • 95. BETA TITANIUM  Properties inbetween SS and Ni Ti  Called as Titanium Molybdenum alloy (TMA)
  • 96.  Offers a highly desirable combination of strength, springiness and formability.  Modulus of elasticity less than SS but more than Ni Ti  Excellent choice for auxiliary springs and for intermediate and finishing archwires  Especially rectangular wires for the late stages of edgewise treatment
  • 97. ARCHWIRE SIZE AND SHAPE  Based on cross section  Round  Square  Rectangular  Multistranded
  • 98. WIRE SIZE  Specified in thousands of an inch  Eg, .016 inch =16 mil  16 mil → 16/4 = 04 → 0.4 mm  40 mil → 40/4 = 10 → 1.0 mm
  • 99. ARCH FORMS  Round/Ovoid  Square  V shaped/Tapering
  • 100.
  • 101.
  • 102. CATENARY CURVE  Catenary Curve  Premolar-canine-incisor segment of the arch very nicely for most individuals  For all patients, the fit is not as good
  • 103. BRADER ARCHFORM  Based on a trifocal ellipse.  The anterior segment closely approximates the anterior segment of a catenary curve  Gradually constricts posteriorly  More closely approximate the normal position of the second and third molars

Notas do Editor

  1. High strength Low stiffness High range Low formability