FIXED ORTHODONTIC APPLIANCES
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Removable vs. Fixed Appliances REMOVABLE Tipping only No control over root movement Pt’s co-operation Hygienic
FIXED Bodily translation Control of root movement Less dependent on pt’s co-op Less hygienic
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DEVELOPMENT OF FIXED ORTHODONTIC APPLIANCES
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Development of Fixed appliances Early fixed appliances Late 1800s Edward Angle
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EARLY FIXED APPLIANCES
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Development of Fixed appliances Standard Edgewise appliance Early 1900s
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Development of Fixed appliances Pre-adjusted edgewise appliance 1970s Refined manufacturing process with “builtin� adjustments specific for each tooth Advances in material sciences made attachment much smaller www.indiandentalacademy.com
BANDED APPLIANCES
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Bonding to Enamel
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Bonding Surface - Bracket Base
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BONDED APPLIANCES
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Lingual Appliance
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CERAMIC APPLIANCES
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Self Ligating Appliance
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PASSIVE FIXED APPLIANCES
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Components of the Fixed Appliance Bands Molar Tubes Brackets Buccal Tubes Arch Wires Auxiliaries: Elastomeric products, Coil springs, Lingual arches, Extra-oral appliances www.indiandentalacademy.com
Posterior attachments MOLAR TUBES
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Components of the Fixed Appliance Bands Molar Tubes Brackets Arch Wires Auxiliaries: Elastomeric products, Coil springs, Lingual arches, Extra-oral appliances www.indiandentalacademy.com
Anterior Attachments Brackets
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Components of the Fixed Appliance Bands Molar Tubes Brackets Arch Wires Auxiliaries: Elastomeric products, Coil springs, Lingual arches, Extra-oral appliances www.indiandentalacademy.com
ARCH WIRES Maxillary and mandibular Arch form described as “parabolic shaped� Size and cross-section of wires vary Material varies eg. Nickel Titanium alloy (NiTi), Titanium Molybdenum Alloy (TMA), Stainless Steel
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Components of the Fixed Appliance Bands Molar Tubes Brackets Arch Wires Auxiliaries: Elastomeric products, Coil springs, Lingual arches, Extra-oral appliances www.indiandentalacademy.com
Elastics
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EXTRA ORAL FORCES - HEAD GEAR
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Coil Spring
Closed or open coil springs www.indiandentalacademy.com
Pre-Adjusted Edgewise Appliance or The Straight Wire Appliance Larry Andrews - studied normal occlusion and individual tooth positions Developed prescriptions for individual tooth position Elements of “ideal” tooth position are built into the appliance Minimizing active “wire manipulation” The Straight Wire Concept www.indiandentalacademy.com
Pre-adjusted edgewise appliance First order / in-out - Horizontal plane Second order / tip - Mesio-distal angulation Third order / torque - Labio-lingual angulation 3 - Dimensional control of tooth position
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First order or In-out
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Pre-adjusted edgewise appliance First order / in-out - Horizontal plane Second order / tip - Mesio-distal angulation Third order / torque - Labio-lingual angulation
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Second order or Tip
4
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Pre-adjusted edgewise appliance First order / in-out - Horizontal plane Second order / tip - Mesio-distal angulation Third order / torque - Labio-lingual angulation
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Third order or Torque
4
To “Torque� is the least efficient tooth movement using orthodontic appliances www.indiandentalacademy.com
Significance of accurate bracket/band positioning Precise tooth positioning Optimal effect of “pre-adjustment� Occlusion Esthetics Stability
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POSITIONING BRACKETS GENERAL INSTRUCTIONS Rhomboidal shape Disto-lingual wing mark Central scribe line (long axis)
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Maxillary Central Incisors
4
4
• Distance from the slot to the incisal edge = 4mm • From the occlusal, the bracket is centered mesio-distally. • As a guide, approximate the incisal edge of the incisor with the base of the bracket perpendicular to the clinical crown long axis.
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Maxillary Lateral Incisor •Distance from the slot to the incisal edge = 3.5mm 3.5
3.5
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Maxillary Cuspids • Distance from cusp tip to bracket slot = 4.5 mm prominent • The severe angulation and o anatomy of cuspids (10 ) can make placement difficult 4.5 mm• From the occlusal view, the bracket is centered mesio-distally on the prominent buccal developmental ridge. This also corresponds to the clinical crown long axis. This will usually be mesial to the center of the contacts 4.5
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Maxillary Bicuspids • Distance from cusp tip to bracket slot = 4 mm From the occlusal view, the bracket is centered mesio-distally on the prominent buccal developmental ridge. This also corresponds to the clinical crown long axis.
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Mandibular Incisors
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Mandibular Cuspid
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Mandibular Bicuspids
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Maxillary first molar bands
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Mandibular first molar bands
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Palmer notation used in Orthodontics Right
Left
Upper Tooth #
7 2
6 3
2 3 4 5 10 11 12 13
6 14
7 15
Tooth #
31 30 29 28 27 26 25 24 23 22 21 20
19
18
Lower
7
6
7
6
5 4
5
4 5
4
3 6
3
2 7
2
1 8
1
1 9
1
2
3
4
5
Upper
Lower
The bracket height chart is written in Palmer Notation. This notation numbers the teeth starting st nd with the central incisors as 1. The laterals are then 2. The canines are 3. The 1 and 2 st nd premolars are 4 and 5 respectively, the 1 molars are 6 and the 2 molars are 7.
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Bracket Heights from Cusp tip or Incisal Edge nd
st
nd
st
st
nd
st
nd
Right
2 M
1 M
2 B
1 B
Cu
LI
CI
CI
LI
Cu
1 B
2 B
1 M
2 M
Left
Upper
7
6
5
4
3
2
1
1
2
3
4
5
6
7
Upper
Bracket height
4.5 4
4
4
4
3.5 Occ plane
→
Bracket height
3.5
4
3.5
4
4 3.5
3.5 In mm 4
7
4
3.5
4
4
4
4
4
4
4.5 Lower
In mm
4.5
6
5
4
3
4
4
4
4
5
6
4.5 2
1
1
2
3
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7
Lower
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