component of the fix orthodontic appliances and general info

1. By: khaled sadeq

2. DEFINITION:
 Fixed Appliances are devices or equipments that are
fixed to the teeth either by cementation or bonding to
the etched teeth surface , cannot be removed by the
patient and are capable of causing various tooth
movement.

3. advantages and disadvantages of the
F.A when compared with R.A
Advantages: Disadvantages:
1-precise control of tooth
movement.
2-maltible and complex tooth
movements can be done.
3-less dependent on the patient
cooperation.
4-no retention problems
1-compromise the oral hygiene.
2-not esthetic and expensive.
3-need specialist dentist.
4-increase chair time.
5-high possibility of
producing adverse tooth
movement.

4. INDICATIONS:
*Fixed Appliances are indicated when precise
tooth movements are required
1. correction of mild to moderate skeletal
discrepancies.
2. intrusion/extrusion of the teeth.
3. correction of rotation.
4. overbite reduction.
5. multiple tooth movement.
6. closure of extraction spaces, or spaces due
hypodontia, to ensure a good contact
between the teeth.

5. Limitation of fixed appliances
 Attitude of the patient: Lake of motivation on the part of the patient is the
main cause of failure in the orthodontics, the orthodontist should discuss the
treatment aims with the patient, without parents being present.
 Oral hygiene: An excellent standard of oral hygiene must be maintained
through out the treatment, if the oral hygiene is poor there is great possibility of
decalcification, caries is increased and periodontal problems will be more
severe.
 Implication of appliance wear: its unfair to cement a fixed appliance
without first explaining to the patient what the appliance is like, how it feel and
how longer it will have to be worn.
 Cooperation: Cooperation is essential, patient must understand the
necessity for carrying out special instruction, if he is unwilling or not able to do
this then he is not suitable for orthodontic treatment.
 Medical history: patient general medical condition must take into account
before any orthodontic treatment.

6. Components of fixed appliances

7. Active components
SEPARTORS: are used to create
space for banding teeth ,Tight
proximal contacts does not allow
proper banding of teeth.
 PRINCIPLE: It is a device to
wedge the teeth and placed
B/w the teeth.
 TYPES:
1. Metal separators
2. Elastic separators

8. Active components
 ARCHWIRES: is a wire conforming to the dental arch that can be used with
dental braces as a source of force in correcting irregularities in the position
of the teeth.
 and there are a different cross sections;
1. round(0.016 or 0.018 inches)
2. square(0.016 x 0.0.016 or 0.018 x 0.018 inches )
3. rectangular(0.016 x 0.022 or 0.018x 0.025)
 generally there are 3 forms;
1. Oval
2. tapered
3. Square`
 Materials
• Stainless steel/ Cobalt chromium • Precious metal • Nickel-Titanium • Beta-Titanium
• Composite Plastics

9. Ideal Properties of archwiers
1. Springback: It is the ability of a wire to go through
large deflections without being permanently deformed.
2. Stiffness: Stiffness of the wire is proportional to a
diameter of the wire but inversely proportional to the
length or span of a wire.
3. Formability: It is the amount of permanent bending
that a wire will go through before it breaks.
4. Resilience: It represents the energy of a wire that
make it return to its normal shape.
5. Biocompatibilty: resistance to corrosion and
would be tolerant to the tissues of oral mucosa
6. Joinability: ability of the wire to be soldered or
welded.

10. Active components
Elastics: are rubber bands latex
or non-latex material that are
frequently used in the field to
correct different type
of malocclusions,
 Can be worn from 12 to 23 hours a day.
 Non-latex elastics deteriorate less as
compared to the latex elastics in the
oral environment.
 be color coded according to strength.

11. Elastics are used mainly in the following ways
 Class I elastics: These are intra-arch
elastics placed mainly between the molars
and the anteriors in the same arch They are
used to close the extraction spaces by
retracting the anteriors (lighter force
elastics) or protraction of posterior teeth
(heavier force elastics).
 Class II elastics: These are
intermaxillary elastics placed between the
mandibular molars and maxillary anterior.
These elastics may be used to produce
extrusion of maxillary anterior or decrease
the over jet by retracting the maxillary
anterior.

12. Elastics are used mainly in the following ways
 Class III elastics: These are again
intermaxillary elastics placed between the
maxillary molars and mandibular anteriors.
These are generally used in the treatment of
Angles Class III malocclusions to bring
about the retraction of mandibular anteriors
and protraction of the maxillary molars.
 Diagonal elastics: These are worn
generally for the correction of midline
deviations. The elastic is worn across the
anterior teeth diagonally.

13. Elastics are used mainly in the following
ways
 Cross bite elastics: These intermaxillary
elastics are used to correct cross bites in the
buccal segments. Their placement is dependent
upon the tooth in cross bite, generally from the
palatal surface of the maxillary molars or
premolars to the buccal of mandibular molars or
premolars. Small dimension elastics are used for
this purpose.
 Box elastics: These elastics are used to
correct anterior open bites. They extend between
the maxillary and mandibular anteriors like a
‘box’, causing the distal tipping of the maxillary
anterior and/or forced eruption of the maxillary
and/or mandibular anteriors.
 Extra oral elastics: These elastics are
used in conjunction with extraoral appliances like
a face mask

14. Active components
Springs: Various types of springs are used
as auxiliaries to generate tooth moving forces.
Springs are mainly used for tooth uprighting
and torquing . Springs may be used to open
spaces (open coil springs) or to close spaces
(closed coil springs). Springs used along with
the fixed orthodontic appliances are:
1. • Uprighting springs
2. • Rotating springs
3. • Torquing springs
4. • Open coil springs
5. • Closed coil sprin

15. Active components
Magnets: they have been used
along with the fixed orthodontic
appliances for the purpose of space
closure as well as regaining lost space.
For the purpose of space closure, they
are used in attraction mode and for
regaining lost space in repulsion
mode. Magnets used presently are:
 • Samarium cobalt magnets—SmCo5
and Sm2Co17
 • Neodymium iron boron magnets—
Nd2 Fe14B

16. Passive components
 Brackets: A bracket is defined as a
device that projects horizontally to
support auxiliaries and is open on one side
usually in the vertical or horizontal.
 The force required for orthodontic tooth
movement is transmitted from the active
components through the bracket.
 Brackets can be classified according to
Material used in Manufacture;
1. Metal
2. Plastic
3. Polycarbonate
4. Fibre glass reinforced plastic
5. Polyurethane
6. Titanium
7. Ceramic

17. Passive components
 Morphology of the Bracket
1. • Siamese
2. • Mini-twin
3. • Single wing
4. • Self-ligating

18. Passive components
Bands: are thin strips of stainless steel
which are adapted to the contours of the
tooth(mostly molars), to which attachments
are welded or soldered like buccal tubes.
 TYPES :
 1. Preformed 2. Custom made
 1. Molar Bands 2.Premolars 3.Incisors
 Uses:
1. preferred on teeth that are likely to
experience excessive forces, e.g. mandibular
molar, mandibular premolars, maxillary
second molars or anterior teeth in cross bite,
2. teeth that have large metal restorations
(structurally weak) or having metal
prosthesis/ crowns (bondings is difficult
or weak)

19. Passive components
Limitation ;
 tight interproximal contact
make it impossible to seat a
band.
 So, separators must be used
before seat the band.
 Main methods;
1. Brass wire twisted tightly
around the tooth for 5-7 days.
2. Separator springs .
3. Elastomeric separators.

20. Passive components
Molar tube: Buccal tubes are horizontal
hollow tubes, round, rectangular or oval in
shape. They are generally used on molars and
help provide better three dimensional control
of these anchor teeth.
 Classification based on mode of
attachment;
1. • Weldable—can be welded on-to
bands
2. • Bondable—bonded directly to
the tooth surface

21. Passive components
Accessories:

23. How to attach a fixed appliance to the
tooth??
BANDS FOR ATTACHMENTS. BONDED ATTACHMENTS.
1. SEPERATION
2. FITTING BANDS
3. CEMENTATION
Disadvantages:
1. Less esthetic.
2. More caries and gingival plaque.
3. Discomfort to the patient.
4. Cannot use in partially erupted
tooth.
5. Require separation.
6. Detachment is difficult.
7. Space remain after treatment.
 Mechanical locking of an adhesive
to irregularities in the enamel
surface of the tooth and to
mechanical locks formed in base of
the 0rthodontic attachment.
 COMPONENTS OF THE SYSTEM :
1. Tooth surface and its preparation.
2. The design of the attachment
base. 3. Bonding material itself.
 By two main methods:
1. Direct Bonding
2. Indirect Bonding

24. BONDED ATTACHMENTS
Direct Bonding
 1. Cleaning
 2.Acid etching
 3.A small amount of bonding
agent is squeezed into the mesh
on the back of the bracket , and it
is pressed to place on the tooth
surface.
 4.Excess bonded material is
removed from around the bracket
 5.For light cured materials, a
cordless light is used to activate
the adhesive bonding process
 6.The bracket is bonded in place.

25. BONDED ATTACHMENTS
 Indirect Bonding
 1.Brackets are placed precisely on a cast of
the teeth and held in place with a fitted resin
 2.After the brackets are cured in the ideal
position, a transfer tray is formed and placed
on the working cast.
 3 The trays are removed from the working
cast after soaking in warm water and
trimmed.
 4. The teeth are isolated , etched, and a
chemically cured to a resin that is painted
on the etched enamel and brackets.
 5. After the resin has completely set , the
trays are carefully removed , leaving the
brackets bonded to the teeth.

26. Tooth movement with fixed appliance
 principles of fixed Appliance
 Tooth movement with fixed appliance is achieved by interaction
between the attachments on the tooth surface and the archwire which
is tied into the attachments.
 As the fixed appliance is attached to the tooth surface , so is capable of
a greater range of tooth movement than that is possible with removable
appliance .
 When the archwire pass through the bracket slot, a force couple can be
generated by the interplay between them , thus rotational and apical
movement are possible .
 The interplay between the archwire and slot determine the type and
direction of tooth movement.

27. Types of Tooth movement with fixed
appliance
 1)Bodily movement
(Translation): is shifting the
tooth along the occlusal plane
without changing the
orientation of the long axis.
 2)A)Crown tipping: is the
tilting of the crown of a tooth
without moving the apex of
the root.

28. Tooth movement with fixed appliance
 3)B)Root tipping: is tilting
the root of the tooth without
moving the crown.
 4)Torquing :is to move the
tooth buccolingually around
the centerpoint, so the crown
and root move in opposite
directions. It is the twisting
force which is traditionally
required to adjust the
inclination of a crown.

29. Tooth movement with fixed appliance
 5) Rotation: is turning a
tooth about its long axis.
 6) Extrusion: is moving a
tooth out of the supporting
structures.
 7) Intrusion:is moving a
tooth into the supporting
structures.

30. Tooth movement with fixed appliance
 8) Distalization: is moving a
tooth along the occlusal plane
away from the midline.
 9) Mesialization: is moving a
tooth along the occlusal plane
towards the midline.

31. Tooth movement with fixed appliance
 10)Expansion:is moving
posterior teeth outwards
away from the midline.
 11)Proclination: is
tipping the crown of anterior
teeth labially.
 12) Lingualization: is moving
teeth towards the tongue side
of the arch.