ESTHETIC ORTHODONTICS
INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
Orthodontic patients – their demand development of appliances acceptable aesthetic for the patient adequate technical performance for the clinician
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Tooth Colored Mini Plastic Ceramic Hybrid
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Tooth Colored ď‚ž
Early attempts to coat metal brackets with a tooth colored coating were unsuccessful due to failure of the coating to adhere and its translucence.
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Mini Brackets ď‚ž
There was a firm trend towards the development of smaller stainless steel brackets.
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Although these generally provide the technical performance required by the orthodontist, they offer little aesthetic advantage over conventionally sized appliances.
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Plastic Brackets
Introduced during 1970s Initially – unfilled polycarbonate brackets Disadvantage – Creep deformation
– Deteriorate in appearance – Friction
Polycarbonate brackets (1990s) Ceramic-reinforced Fiberglass-reinforced Metal slot-reinforced
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Ceramic Brackets
An attempt to improve esthetics while maintaining bracket strength has resulted recently in the development of a ceramic bracket.
Alumina Monocrystalline Polycrystalline
Zirconia www.indiandentalacademy.com
Ceramic Brackets
Single-crystal alumina – most translucent
Poly-crystal alumina – less than singlecrystal
Zirconia – inferior esthetics Greater opacity, yellowish tint
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MONOCRYSTALLINE CERAMIC BRACKET Starfire Inspire
POLYCRYSTALLINE ALUMINA CERAMIC BRACKETS MXi (TP ORTHODONTICS)
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Hybrid Brackets ď‚ž
Two or more polymers
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These have properties intermediate between those of the constituents
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Materials should be so chosen that the property of one constituent improves the deficient property of others
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Epoxy-coated Optiflex
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Esthetic Arch wires
Coated Arch wires
Composite Arch wires
(elastomeric poly-tetra-fluorethylene emulsion)
(Optiflex)
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Epoxy Coated Wires
Epoxy coated tooth-colored arch wires with a NiTi (superelastic) or stainless steel core.
Advantages: Superior wear resistance and color stability Retains superelastic qualities More natural looking than white coatings
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Optiflex ď‚ž
Optiflex is a new orthodontic arch wire designed to combine unique mechanical properties with a highly esthetic appearance.
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Made of clear optical fiber, it comprises three layers 1. 2. 3.
A silicon dioxide core that provides the force for moving teeth. A silicon resin middle layer that protects the core from moisture and adds strength. A stain-resistant nylon outer layer that prevents damage to the wire and further increases its strength.
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Essix ď‚ž
Essix retainers are clear, thin cuspid-to-cuspid appliances appliances that snap into place and are retained, without clasps, by the many natural undercuts gingival to the anterior contact points.
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They are fabricated from .030" Essix plastic sheet, which is reduced to .015" during thermoforming.
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Additionally, tooth movement is possible in all planes of space.
Two types of space that must be evident for tooth movement with Essix appliances are space within the appliance and space within the dentition
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Methods of applying force in the Essix System: 1. Spot-thermo forming 2. Mounding
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Spot Thermo-forming
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Mounding
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SPACE CLOSURE
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Invisalign
Was the brainchild of Zia Chishti and Kelsey Wirth, graduate students in Stanford University's MBA program.
Kelsey Wirth had traditional braces in high school, which she reportedly hated whereas Zia Chishti had finished adult treatment with traditional braces, and now wore a clear plastic retainer. He noticed that if he did not wear his retainer for a few days, his teeth shifted slightly -- but the plastic retainer soon moved his teeth back the desired position.
Together they started Align Technologies in April 1997 and with the help of a handful of forward thinking orthodontists, they applied 3-D computer imaging graphics and created the Invisalign method. www.indiandentalacademy.com
Steps Step 1 - Diagnosis and Treatment Plan Step 2 - Polyvinylsiloxane Impressions and Bite Registration Step 3 - The Digitization Process Step 4 - ClinCheck Step 5 -Manufacture of Appliances
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Indications
mild spacing (1 - 3 mm), moderate spacing (4 - 6 mm), mild crowding (1- 3 mm), moderate crowding (4 - 6 mm), narrow arches that are dental in origin (4 6 mm), as well as patients who have relapsed following conventional orthodontic treatment www.indiandentalacademy.com
Fiber-Reinforced Composites ď‚ž
Long-fiber composites can be used as adjuncts for active tooth movement
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The FRC rope or strip is cut to length, and the protective transparent foil is gently removed.
The tooth is prepared for bonding with the conventional polishing and etching.
The FRC is placed in position and contoured to the tooth, then light-cured to form an effective connecting bar. www.indiandentalacademy.com
Clinical Use of FRC
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Retainers Kesling Positioner Invisible Retainers Essix Retainer
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Lingual Orthodontics
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History
During the early 1970’s, Dr.Craven Kurz, an orthodontist, then Assistant Professor of occlusion and gnathology at the UCLA School of dentistry found his private orthodontic practice to be increasingly dominated by adult patients.
A particular patient who was an employee of playboy, bunny club, presented to his practice requesting treatment. Because of her public position, she refused metal or plastic labial appliances on esthetic grounds.
From her demand for an appliance that did not show, the concept of a lingually bonded appliance was born. www.indiandentalacademy.com
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List of difficulties encountered during the development of the lingual appliance: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
Tissue Irritation and speech difficulties Gingival Impingement Occlusal Interference Appliance Control Base pad Adaptation Appliance placement and bonding Appliance Prescription Wire placement Ligation Attachments www.indiandentalacademy.com
Generation 1 Ormco manufactured the
first Kurz lingual appliance. Flat maxillary occlusal bite plane from canine to canine. Lower incisor & PM brackets were low profile & half round. No hooks on any brackets.
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Generation 2 ď‚— Hooks were added to
all canine brackets
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Generation 3 Hooks were added to
all anterior & PM brackets. The first molar had bracket with internal hook. The second molar had terminal sheath without hook
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Generation 4 ď‚— Low profile anterior inclined plane in central
& lateral incisor. Hooks were optional based on treatment needs & hygiene concerns
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Generation 5 Increased labial
torque in the maxillary anterior region. Canine had an inclined plane with bibevelled. Hooks were optional.
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Generation 6 Maxillary inclined plane is square in shape.
Hooks available in all brackets & are elongated.TPA attachment is optional. Hinge cap available for molar brackets.
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Generation 7 ď‚— Maxillary anterior inclined plane is heart shaped
with short hooks. Premolar brackets were widened mesiodistally for better angulation & rotational control. Molar brackets with hinge cap or terminal sheath
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Advantages Intrusion of anterior teeth Maxillary arch expansion Combining mandibular repositioning
therapy with orthodontic movements Distalization of maxillary molars
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www.indiandentalacademy.com Leader in continuing dental education
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