Fixed Appliances Components and Leveling and Alignment

By: Sadaf Sajjad Class No: 565 Final yr BDS

Orthodontic Appliances
Defined as devices, which creates or transmit force to individual or a group of teeth or maxillo-facial skeletal units so as to bring about changes within the bone with or without tooth movement which will help to achieve the treatment goals of functional efficiency, structural balance and esthetic hormony.

Classification
On the basis of patients ability to remove orthodontic appliances.

Fixed

Removable

Semi-Fixed

Cont
Based on the way they generate or transmit force.

Mechanical

Functional

Fixed Appliance
An orthodontic device in which attachments are fixed to the teeth and forces are applied by archwires or auxillaries via these attachments

Requirements Of Fixed Appliances

1. 2. 3. 4. 5. Suitably trained operator Fully motivated patient Patient with excellent oral hygiene, caries control. 18 to 24 months + 6 months duration Visits 4 to 6 weekly

Indications
Grossly misplaced teeth Lower arch treatment Space closure Incisor relationship Multiple tooth movement

Advantages
Any type of tooth movement can be carried out. No dependence on patient compliance . Multiple tooth movements . Can be used in cases requiring extraction of 4,5,6. Shows better alignment results as compared with removable appliances. Extra oral forces can be used simultaneously. Precise tooth control is possible.

Disadvantages
1. 2. 3. 4. 5. 6. 7. Aesthetics Difficulty in oral hygiene maintenance Demanding in terms of materials and operator time. Anchorage control / treatment monitoring more difficult Expensive treatment Pain , ulceration , irritation seen in some patients Relapse

Components
Depending upon the ability to generate force:  Active  Separators  Archwires  Elastics  Springs  Magnet  Ligature wires  Passive  Bands  Brackets  Buccal tubes  lingual attachment  lock pins

Depending upon the fixed orthodontic appliance used :1:ATTACHMENTS:*Bands *Brackets 2:ARCHWIRES:*Initial wires *Intermediate wires *Finishing wires 3:AUXILLARIES

Auxillaries
Elastic Ligatures / O-rings Wire ligatures Used to tie arch wires to brackets Springs Elastics Power Chain

Separators

A device to force or wedge the teeth apart, is left in place long enough for initial tooth movement to occur so that the teeth are slightly separated in which the bands can be fitted.

Brass Separator
Initially soft brass wires were passed interdentally and twisted to create space. Disadvantages:  Painful  Uncontrolled Force  laceration injuries to the buccal mucosa &/or gingival

Two main methods of separation are used for posterior teeth. 1. Separating Springs Made of 0.016 inches of wire with helices at the closed end.  Method Using a plier which is called weingart plier  Advantages  Disadvantages Sufficient space is created within 48 hours of application. 2. Elastomeric Separators It can be ring separators or dumb-bell  Method Using special pliers Using dental  Advantages  Disadvantages

Archwires
The Archwire is tied to in the bracket slot with the help of ligatures. Archwires are of different alloy, type, shape, size and force.

Types of Archwires
Based on material constituents:
       Stainless steel Nickel titanium Cobalt chromium Co-axial(multistranded) Tungsten molybdenum(TMA) Composite coated Optiflex archwires

Based on the cross section of the wire

    Round Square Rectangular Miscellaneous

Based on the diameter of the archwires:  Round -> 0.08 , 0.10 , 0.12 , 0.14  Square -> 0.16 x 0.16 , 0.17 x0.17  Rectangular -> 0.17 x 0.25 , 0.17 x0.28 According to micro structural arrangement:  Simple Cubic  Face centered Cubic  Body centered Cubic

Stainless steel alloys

Composition :Fe-70 % Cr-18% Ni-8% Co-15% Large modulus of elasticity (stiffness) Solderable Good corrosion resistance Lower springback Super grades, regular grades, dead soft wires

Cobalt chromium alloys

Elgiloy or CoCr Co- 40% Cr-20% Ni-15% Fe-15.8% Mn-2% Available in softer state and formable state and can be hardened by heat treatment after being shaped.

NiTi alloys
Ni ; 52% Ti; 45 % Co; 3 % EXCELLENT SPRINGBACK AND FLEXIBILITY SHAPE MEMORY THERMOELASTICITY SUPER ELASTICITY PRESENT IN 2 STATES MARTENSITIC AUSTENITIC

BETA TITANIUM(TMA)
Ti;77 % Mo; 11 % Zr ; 6 % HIGH MODULUS OF ELASTICITY(lower than ss but twice of NiTi Reasonanbly good formability Excellent choice for auxilliary springs and immediate and finishing arch wires

Brackets
Metal;
A. stainless steel B. Gold poor esthetics

Plastic
becomes stained

Ceramic
prone to fracture because enamel wear

Combination of Plastic & Ceramic

Bonding
Bonded attachments(brackets) are attached to enamel using composite Types of bonding : Direct Indirect

Bands
These are metal rings encircling the tooth to which buccal and often lingual attachments are welded. Mostly seated on molar and premolar bands as they can resist more occlusal load. In addition a molar band is more secure where headgear is to be used. TYPES: Preformed Customized

AUXILIARIES

 Leveling and Alignment

WHAT IS LEVELING AND ALIGNEMENT

LEVELING: to reduce the curve of spee by intrusion and/or extrusion of teeth in an arch

ALIGNMENT: to move the teeth into their proper positions to conform to the line of occlusion

 ALIGNMENT USING A FIXED APPLIANCE

Alignment requires a wire with the following specification

>High strength
>Low stiffness > Excellent springiness >Almost flat load-deflection curve >High range

 Material - NiTi and TMA Size of wire smallest diameter Distance between attachments increased leading to decreased strength and increased springiness

 Shape Round wires produce uncontrolled tipping because they cannot produce a counterbalancing couple.

Rectangular wires produce controlled tipping because they produce a counterbalancing couple.

Principles in the choice of alignment wires

It should provide light, continuous force of approx 50 gms. It should be able to move freely within the brackets .

Types of fixed appliances

Begg lightwire technique Edgewise technique Lingual orthodontics Straight wire appliance

 Edgewise appliance: for alignment of symmetric and asymmetric crowding

Begg technique

THE EDGEWISE APPLIANCE

The archwire channel is rectangular in cross section with the largest dimension horizontal The bracket maybe solid or siamese Can be used with rectangular and round cross section wires

Begg s apliance
Narrow slot which corresponds to arch wire channel of the edgewise bracket Minimal mesiodistal width Used only with round cross-section archwires Arch wire is a loose fit in the bracket Not possible to actively upright or torque teeth Advantages and disadvantages

Alignment of symmetric crowding with egdewise appliance

 Choice of an archwire --- NiTi Alignment in extraction situation (pre-molars)

Severe crowding in anteriors: - retract canines into premolar sites Less extreme crowding: - Simulataneously tip canines distally and align the incisors

ALIGNMENT IN NON-EXTRACTION SITUATION

ALIGNMENT Requires increasing arch length
Superelastic wire: - Cannot be accomplished by just tying - crimp a stop on the wire at the molar tube - carries the incisors facially Multistrand wires: - bend a loop mesial to the molars so the wire is just anterior to incisors.

that

 ALIGNMENT OF ASYMMETRIC CROWDING WITH THE EDGEWISE APPLIANCE

 Utilizes a stiff main arch on all teeth except the displaced ones (16 or 18 steel) with the addition of a small diameter superelastic wire. Segment of superelastic NiTi can be: - Laid in brackets on top of the main arch wire - Tied below brackets of the anchor teeth - Tied to the bracket on the displaced tooth

 ALIGNMENT WITH BEGG TECHNIQUE

TECHNIQUE
Brackets provide maximum possible interbracket distance without placing loops Initial wires bypasses the premolars and span the molar to canine Alignment loops are a valuable adjunct Long posterior span of wire prevents use of highly flexible Ti based arch wire Wire should be flexible anteriorly and stiff posteriorly

SPECIAL PROBLEMS IN ALIGNMENT

Cross bite correction

Impacted or unerupted teeth

Diastema closure

Cross bite correction

Individual teeth displaced into Anterior cross bite : Opening enough space, then bringing the displaced tooth or teeth across the occlusion into proper position.

 Posterior cross bite: Skeletal Achieved by opening the midpalatal suture May or may not be complemented by extraction of 4 s Makes use of hydrax expander Expansion can be either rapid (10-20 pounds) or slow (2-4 pounds) Both require same amount of time Relapse can be expected

 Dental :- Expansion of molars 3 approaches 1- Heavy labial expansion (facebow) 2- Expansion lingual arch 3- Cross-elastics

Space closure
If there is space in either arch, closure generally takes place after leveling and aligning. The arch wire must be stiff enough to withstand the force necessary to move teeth bodily (stainless steel wire). Diastma closure : Frena must not be removed at early age, opt for alignment before frenectomy Sliding along a wire is better than using closing loops If unsuccessful, perform frenectomy and immediately start diastema closure

IMPACTED OR UNERUPTED TEETH

Presents 3 problems

1- Surgical exposure 2- Method of attachment 3- Mechanical approaches for aligning

LEVELING

 Leveling by extrusion: 18-Slot, Narrow brackets

22-Slot, Wider brackets

Leveling by intrusion: Bypass arches

Segmental arch wires

LEVELING BY EXTRUSION
Accomplished with continuous arch wires. Choice of wire ---depends on the type of bracket Slightly stiffer than that used for alingnment initially.

18 SLOT, NARROW BRACKETS

Utilizes a 16 mil steel or, a 16 or 18 mil M-NiTi with an extremely exaggerated curve. Wires available for 18 slot cannot accomplish all tooth movements.

22 SLOT, WIDER BRACKETS

Initial alignment with 17.5 mil twist or 16 mil A-NiTi wire Followed by a 16 mil steel wire with reverse or accentuated curve To complete the leveling, 18 mil round wire is used

LEVELING BY INTRUSION
Successful intrusion is by light continous force directed toward the tooth apex 2 ways: continous arch wires and segmented arch wires Accomplished by: - Bypass arches - Segmented base arch wires

 Thank you