FIXED ORTHODONTIC

APPLIANCES
INTRODUCTION TO FIXED APPLIANCE.
 Appliances that are fixed or fitted onto to the teeth by
the operator & cannot be removed by the patient at
will are called fixed appliance.
Advantages:-

 Can do complex tooth movement

 Better control over tooth movement
 Better control of anchorage & extraoral force can be
used in conjunction with fixed Eg: Head gears.
 Does not require pt co-operation
 Better aligning, detailing & finishing of the occlusion
Disadvantages:-

 Difficult to maintain good oral hygiene

 More time consuming to fix & adjust
 More conspicous and not esthetically pleasing
 Requires special training of the operator
 Patient visit the orthodontist at regular intervals
 Comparatively expensive
 Various tooth movement brought about by fixed
appliances:
 Tipping
 Bodily movement
 Torquing
 Uprighting
 Rotations
 Extrusion & Intrusion
 Tipping:- Here the crown moves in the direction of
force around a fulcrum in the apical region of the
root. Root apex moves in opposite direction.
 Bodily movement:- Equal movement of both the
crowns as well as the root in the same direction.
 Torquing:- Root movement in the labial or lingual
direction
 Uprighting:- refers to mesio-distal movement of
the roots.
 Extrusion & Intrusion:- refer to Vertical movements
of teeth along their long axis.
History:-
 The irregular position of teeth has been a problem for some individuals since
the beginning of time. Attempts to correct this disorder go back to at least
1000BC.
 1850 AD:- The first texts which systematically described orthodontics
appeared. Dr. Norman Kingsley was among the first to use extraoral force to
correct protruding teeth.
 1890's AD:- Dr. Edward Angle "The father of Modern Orthodontist'' was one
of the first to emphasize occlusion in the natural dentition. His interest in
creating proper occlusion in natural teeth created the specialty of
orthodontist.
 1900'AD:- With a concept of normal occlusion established by Angle,
orthodontist began to enable into the treatment of malocclusion and not
just the straightening of teeth.
 1940'AD:- Cephalometerics radiographs were developed which allowed the
orthodontist to see how he bones of the face contributed to malocclusion.
 1970's AD:- Surgical technique developed which allowed oral surgeons to
perform surgery on patients who did not have the ability to grow any longer.
 PRESENT ORTHODONTICS:-
 Uses a combination of extraoral forces to align teeth as well as growth
modification, surgery and extractions to accomplish 3 goals.
 Create the best occlusal relationship
 Create acceptable facial esthetics
 Create a stable occlusal result

 DIFFERENT TECHNIQUES:-
 The edgewise arch mechanism was [Link] last and greatest
contribution to orthodontics.
 The edgewise mechanism was designed to allow the orthodontist to
place the teeth into Angles concept of the 'line' of occlusion' defined as
 ''the line with which in form and position according to type, the teeth
must be in harmony if in normal occlusion.''
 The evolution of this appliance and its recommended use can be traced
by following Angle's earlier works in appliance design.
 ANGLE E Arch:
 The simple [Link] which was used primarily for
tipping tooth crowns into proper alignment, was the
first in a long series of Angle appliances. It was the
first to utilize stationary anchorage or bodily control
of first permanent molar teeth, which were fitted
with clamp bands. The expansion arch was threaded
to form a traction screw arrangement attached to
the buccal of the anchor bands.
 PIN & TUBE APPLIANCE:

 The shortcomings of this approach became apparent to Angle and he set

about to device a means for more individual tooth control. The pin and
tube appliance by which the tooth roots could be brought into proper
axial relationship with the crowns was a logical consquence. This was the
first appliance developed by angle that employed a bracket and used
bands on most of teeth. However despite it potential versatility,
difficulties were encountered with the actual manipulation of the
technique. Noyes commented that the pin and tube appliance
demanded such a high degree to skill to obtain proper parallelism b/w
the tubes & pins on the archwire that few would be able to master the
technique. Soldering & unsoldering the pins at each adjustment was time
consuming and tedious. The appliance design made rotational
adjustments most difficult
RIBBON ARCH APPLIANCE
 The ribbon arch appliance introduced in 1915, was the next step in the
evolution of took alignment devices. It was actually the first bracket as such
to be used in an orthodontic appliance. It obviously was a great step forward
and in fact was a testament to the genius of Angle insofar as the light wire
technique of P. Raymound Begg of Australia was built around this bracket.
Begg and his co-workers modified it only slightly. Both the Begg technique
and the ribbon arch technique require a locking pin for attachment of the
archwire to the bracket.
RIBBON ARCH APPLIANCE
 One of the main advantages of the ribbon arch appliance is that it
alones rotations to be readily accomplished. It also offers control of
buccolingual and labiolingual movements and both incisogingival
and occlusogingival movements are possible. The primary short using
of the ribbon arch appliance as originally developed was that it made
mesiodistal axial movements difficult to obtain. This inability to
achieve distal tipping movements of buccal segments proved to be a
serious handicap. Experience showed, furthermore that the size of
the ribbon arch itself did not provide the stability thought necessary
for stabilization or anchorage of the posterior teeth. It should be
noted that the original ribbon arch technique , as developed by angle,
was non-extraction oriented, in contradistinction to the current usage
of the ribbon arch bracket in the Begg technique for both extraction
and non-extraction treatment.
EDGE-WISE APPLIANCE

 To overcome the deficiency of ribbon arch Angle re-

oriented the slot from vertical to horizontal and
inserted a rectangular wire, rotated 900 to the
orientation it had with ribbon arch thus the name
edge wise.
 Preajusted edge wire (straight wire) – tip and torque
pre adjusted into wire.
 BEGG APPLIANCE:-
 Raymond Begg received his training in orthodontics from Angle school during the early
1900's the later returned to Australia in 1925 and practised the edgewise technique. In the
mean time Begg modified the Angle's ribbon arch technique & introduced the Begg light
wire differential force technique. This appliance used the concept of differential force and
tipping of teeth rather than bodily movement. Begg appliance used high strength stainless
steel wire along with a number of auxillaries and springs to achieve the desired tooth
movement.
Treatment using Begg appliance is carried out in 3
different stages.

 Stage one - concerned with alignment,

correction of crowding, rotation correction,
closure of anterior space and achieving an edge
– edge anterior bite .

 Stage two- Remaining extraction spaces are

closed while
maintaining the previous corrections that have
been achieved.
 Final Stage - Uprighting and torquing is carried
out to achieve normal axial inclination of
teeth.
 STRAIGH WIRE APPLIANCE

 The straight wire technique is a recent modification of the

edgewise appliance introduced by [Link] in the 1970's,
based on his 6 keys to normal occlusion. The basic concept
was to programme the bracket to have the first, second and
third order components so that the wire need not have any
complex bending as required in edgewise [Link] it
is called Preadjusted Edgewise Appliance. This technique
made it possible to substantially reduce the wire bending
required and also enabled good finishing of cases.
LINGUAL TECHNIQUE

 The lingual orthodontic technique was introduced in

1976 by Craven Kurz. In this technique the brackets
are placed on the palatal & lingual aspects of the
teeth. Both the edgewise and Begg principles can
be employed in treatment. Lingual appliances are
highly esthetic but have the disadvantage of poor
access and difficulty in speech and maintaining the
oral hygiene.
BANDIING AND BONDING:-
Bonding:-

 The origin of orthodontic bonding dates to 1955 with the publication of

the original work by Buonocore who demonstrated improved retention
of methyl methacrylate resins to enamel after 30sec application of 85%
orthophosphoric acid. In 1965 Newman reported on the use of epoxy
adhesives for the bonding of orthodontic attachments to teeth. He was
the first to use the acid etch technique for this purpose. The last major
development was by Bowens who developed a bisGMA resin that proved
to the more stable than the previous resins. Currently available bonding
resins are based on Bowen's bisGMA resin. .
 Advantage:-
 More esthetically acceptable.
 Easier oral hygiene maintenance.
 Partially erupted teeth can also be bonded.
 Risk of caries is eliminated.
 Proximal stripping is possible.
 Less chair side time.
 Proximal areas are available for restoration.
 Disadvantage:-
 It is a weak attachment
 Risk of enamel demineralization
 Enamel fracture can occur during debonding
 More boding failure
 Types:-
 Direct Bonding
 Indirect Bonding
 Steps:-
 Polish the teeth with pumice powder to remove pellicle.
 Etching 35-50% of buffered orthophosphoric acid for 30 – 50sec.
 Wash the etchant
 We can visudisc a frosty white appearance
 Apply sealent on the tooth surface.
 Hold the bracket in reverse tweezer, apply sealant and adhesive over the
bracket and selfcure or light cure it.
 Position the bracket and press to remove the excess material which has
to be removed to avoid white spots on tooth.
 After sometime apply arch wire
BANDING

 Banding involves the use of thin stainless steel strips called

bands that are pinched tightly around the teeth and then
cemented to the teeth. The stainless steel tape is available in
different width and thickness to suit different teeth. While
the molar band material is wider and stiffer, the anterior
band material is relatively thinner and narrower in width. The
outer surface of the band material is smooth and glassy
while the inner surface is comparatively rough and dull, so as
to aid in retention of the cement.
 Indications for banding
 In cases of posterior teeth banded attachments resists
occlusal forces.
 It is preferable to band a tooth that requires buccal as
well as lingual attachments.
 Band are better likely to resist heavy forces, as in the
case of extraoral devices such as head gears.
 Although it is possible the band attachments on teeth
that have porcelain or gold restorations or crowns
banding is preferred in these cases.
 It is preferable to use banded attachments whenever
they are likely to contact the opposing dentition when
the joins are closed.
 Steps in banding
 Separation of teeth
 Tight contacts should be broken using tooth separators prior to band pinching.
 Different type of separators used are:
 Ring separator
 Dumbbell separator
 Brass wire separator
 Keslings spring separator.
 Selection of band material
 Pinching of the band
 using a band pinching pliers, the band is tightly drawn around the tooth to form a
ring. The bent portion is spot welded and the gingival margins of the bank are
trimmed to conform to the contour of the gingival margin
 Fixing the attachment.
 Attachments include brackets for the anterior teeth and buccal or molar tubes
for the posterior teeth.
 Cementation of the band.
 During cementation, adequate moisture control is necessary by means of
saliva ejectors and cotton roles. Cements used are zincpolycarboxylate,
zincphosphate, glass ionomer cement etc.
 COMPONENTS
 ACTIVE COMPONENTS
 Arch wires
 Springs
 Elastics
 Separators
 PASSIVE COMENTS
 Bands
 Brackets
 Buccal Tubes
 Lingual Attachments
 Lock pins
 Ligature wire
 ARCH WIRES:-
 They can bring about various tooth movements through the medium of
brackets and buccal tubes which act as handles on the teeth.
ARCHWIRES
 Ideal Requirements
 Spring back:- measures how far a wire can be deflected with out causing permanent
deformation.
 Stiffness:-
 Formability:- Wires exhibit high formability so as to bend the arch wires into disired
configuration as coils,loops etc.
 Resilience:- The amount of force the wire can withstand before permanent deformation.
 Bicompatibility environmental stability
 Joinability
 Friction
 Classification of arch wire
 I Based on material used
 Gold and Gold allays
 Stainless steel
 Nickel titanium alloys
 Beta titanium
 Cobalt chromium nickel alloys
 Optiflex arch wires.
 II Based on cross section
 Round
 Square
 Rectangular
 Multiistranded.
 Gold & gold alloys :- Prior to 1940, gold was extensively used in the
manufacture of orthodontic wire.
 Stainless Steel:- Austenitic stainless steel referred to as 18/8 is used to
make orthodontic arch wire.
 Nickel Titanium alloys:- (Nitinol) have super elasticity and but reduced
formability and cannot be soldered or welded.
 Beta:- titanium:- (T.M.A wires)
 Cobalt chromium nickel alloy(Elgiloy)
 Optiflex arch wires:- made of clear optical fibers and are highly esthetic
with high resilience
 Multithreaded arch wires:- can be trusted or coaxial in form and have
increased flexibility.
ELASTICS

 Begg called it as engine of appliance, made up of latex rubber.

 Types:-
 Class I – Molar to canine (intraarch)
 Class II – lower molar to upper canine
 Class III upper molar to lower canine
 Box elastic – to correct antr open bite
 Cross elastic – used in begg's appliaice
 Transpalatal elastic – to correct molar crossbite
 Elastic chains – Available as long chains if interconnected rings used in closure of space
 Elastic thread – made up if corex of latex rubber and surrounded by a sleave of woven silk
used to derotate of tooth.
 Elastic Modules – Made of 2 elastic rings separated to close space and for derotation of teeth
 Ligating ring's – Archwires can be secured to the brockets using small electrometric rings
called lighting rings.
Springs:

 Uprighting springs: Used to move root is a

mesial or distal direction
 Torquing Springs : Move root in a lingual or
palatal creation
 Open coil springs : Compressed b/o two teeth
to open up space b/o them.
 Closed coil springs : stretched b/w teeth to
close space
 BANDS
 The attachment like brackets and molar tubes are
soldered or welded over these bands which are
cemented in position around the teeth.
 Band sizes thickness width
 (inches) (inches)
 Incisor 0.003 0.125
 Canine 0.003 0.150
 Premolar 0.004 0.150
 Molar 0.005 0.180
0.180
BRACKETS

Act as handless the transmit the force from the active components
to the teeth. Brackets have one or more slots that accept the arch
wire.
Edgwise type of brackets
Has horizontal slot facing labially. Also called as rectangular slots as
they accept wires of rectangular cross section with larger dimension
being horizontal
Ribbon arch brackets:
Has vertical slot facing the Occlusal or gingival direction. Slot is
narrow m-d and are used in begg fixed appliance.
Weldable and bondable brackets
Brackets that are bonded directly over the enamel and those that
are weldable or soldered over the bands.
 Metallic brackets
 Can be recycled and sterilized, resist deformation and
[Link] unesthetic and cause staining of teeth.
 Ceramic brackets
 Are dimensionally stable and do not distort in oral cavity but
are brittle and fracture.
 Plastic brackets:
 Available in tooth coloured or transparent forms but undergo
discoloration and their slots tend to distort.
 Buccal Tubes:
 Can be round or rectangular in cross section. May have
sometimes double or triple tubes. These additional tubes are
for additional arch wires and for face bow insertion.
 Lingual attachments:

 Are fixed on lingual aspect and are required for

engaging elastics
 Eg: lingual buttons
 Lingal cleats,
 Eyelets
 Ball end look
Ligature wires

 Are soft stainless steel wires of 0.009-0.011 inches diameter and are used to
secure the arch wire to the brackets usually necessary in edgewise type of
brackets.
 Lock pins:
 Used to secure the arch wire to brackets with vertical slots such as ribbon arch
brackets and usually made of brass.