FIXED APPLIANCE

There are two clear justification for
orthodontic treatment; aesthetics and
function.

 The goal of orthodontic treatment defined
by Proffit(1993).
 The creation of the best possible occlusal
relationships ,with in the framework of
acceptable facial aesthetics and stability of
the end result.

 Relief of crowding
 Correction of the rotational and apical
displacement teeth.
 Correction of interincisal relationship
 Establishment of satisfactory buccal
intercuspation.
 A pleasing facial appearance.
 A stable end result.

 Grossly misplaced teeth.
 Lower arch treatment.
 Space closure.
 Incisor relationship correction.
 Multiple tooth movement.

 Patient cooperation is dispensed with to a large
extent in the use of fixed appliances.
 It is possible to bring about various types of tooth
movements.
 Multiple tooth movements are possible
simultaneously.
 More precise tooth movements and detailing of
occlusion is possible using fixed appliances.
 Fixed appliances can be used to treat most
malocclusion including very complicated one.
 Fixed appliances offer better control over
anchorage

 The most important one is oral hygiene maintenance
becomes more difficult.
 It is more time consuming to fix and adjust it is more
expensive.
 It requires special training of the operator.
 Damaged appliances that apply misdirected forces
can not be removed by the patient.
 It is more conspicuous than removable.
 Unless it is done by a skilled operator there is a
greater possibility of producing adverse tooth
movements.

 Bodily movement
 Tipping of crown
 Torquing
 Mesio distal uprighting
 Intrusion
 Extrusion
 Rotations

The fixed appliance used in contemporary
orthodontics are based on Angles designs
from the early 20th century. He developed four
major appliance systems.

 E-arch in the late 1800s ,it depends on some
sort of rigid frame work to which the teeth
were tied so that they could be expanded to
the arch form dictated by the appliance.
 It can only tipping movement

 Pin and tube
Pin and tube, Angle placed bands on other
teeth and used a vertical tube on each tooth into which
a soldered pin from a smaller arch wire was placed,
tooth movement was accomplished by repositioning the
individual pins at each appointment.
 Ribbon arch
Ribbon arch, he provide a vertically positioned
rectangular slot behind the tube and a ribbon arch of
10x20 gold wire placed into the slot and held with pins.
But it provide d poor control of root position.

 Angle reoriented the slot from vertical to
horizontal and inserted a rectangular wire
rotated 90 degrees to the orientation it had
with the ribbon arch.
 It allow excellent control of crown and root
position in all three plane of space.

 Begg adapted in three forms
 He replaced precious metal ribbon arch
with stainless steel
 He turned bracket up side down ,so the slot
pointed gingivally.
 Add auxillary springs for control of root
position.

Andrews(1980) developed bracket
modification for specific teeth, to
eliminate the many repetitive bends in arch
wire to compensate for differences in tooth
anatomy.

 Two methods
 Banding
 bonding

 Involves use of thin stainless steel strips pinched
tightly around the teeth and then cemented to the
teeth. Preformed steel bands also available.
Indications :-
 Teeth that will receive heavy intermittent forces
against the attachments.
 Teeth that will need both labial and lingual
attachments ,such as molar with headgear and
lingual arch tubes.
 Teeth with short clinical crowns.

 Selection of band materials
 Separation of teeth
 Pinching of bands
 Fixing the attachments
 Cementation of the bands

 The method of fixing attachments directly
over the enamel using adhesive resins is called
bonding.
 Advantages
 Aesthetically superior
 Faster to bond than banding .
 Maintenance of better oral hygiene.
 Easier to bond partially erupted ,fractured
tooth.
 The risk of caries eliminated.
 Inter proximal areas are available for proximal
stripping.

 It is esthetically superior.
 Faster to bind than to pinch bands around the
teeth.
 Maintenance of better oral hygiene.
 Possible to bond on teeth that have aberrant
shapes or forms.
 Easier to bond in case of partially erupted and
fractured teeth.
 Interproximal areas are accessible for restoration
and proximal stripping

 Weaker compared to banding.
 Acid etching lead to enamel loss.
 Chance of enamel fracture during de
bonding.

 Materials used
 For many years fixed appliance had been
 fabricated entirely from stain less steel. But nickel is a
potentially allergenic materials.
 So titanium arch wires used since 1980
 Titanium is hypoallergenic.
 Material is more wettable so reduce failure rate in
bonding.
 More resilient than steel.
 Non metallic materials used
 Plastic materials
 Ceramics

 Active components
▪ Arch wire
▪ Springs
▪ Elastics
▪ Separators
 Passive components
 Bands
 Brackets
 Buccal tubes
 Lingual attachments
 Lock pins
 Ligature wire

 Bands are passive components that helps in
fixing the various attachments on to the teeth.
They are made of stainless steel and available in
various sizes.

 Brackets act as handles to transmit the force from
the active components to the teeth. Brackets have
one or more slots that accept arch wire.
 Different designs of brackets are available.
 Edge wise type, horizontal slot.
▪ Ribbon arch type ,vertical slot.
▪ Bondable brackets ,mesh work seen under surface
of bracket.
▪ Weldable bracket.
▪ Metallic bracket ,steel brackets are commonly
used.
▪ Individually customized brackets also available
nowadays.

 Advantages :
▪ They can be recycled.
▪ They can be sterilized.
▪ they resist deformation and fracture.
▪ They exhibit the least friction at the wire
bracket interface.
▪ They are not very expensive.
 Disadvantages :
▪ They are aesthetically not pleasing.
▪ Corrode and staining of teeth.

 Advantage :
 They are dimensionally stable.
 They are durable and resist staining.
 Disadvantages
 Very brittle and more chance for fracture.
 Exhibit greater friction at the wire bracket
interface.

Made of polycarbonate.
 Advantage
 Aesthetic value improved.
 Disadvantages
 They tend to discolor.
 They offer poor dimensional stability.
 The friction between plastic brackets and arch
wire is high.

 Buccal tubes:
 The attachment generally used on molars. It can be
weldable and durable.
 Lingual attachments
 It mainly used for engaging elastics, examples cleat,
button, eyelet.
 Ligature wires
 They are soft stainless steel wires of 0.009 to 0.011
inches diameter ,used to secure the arch wire to the
bracket
 Elastomeric nodule also used

 Lock pins
They are small pins used to secure arch wire to
brackets with vertical slots such as ribbon arch
bracket. The lock pins are usually made of brass.

One of the component of fixed appliance. Early day
gold arch wires are used later it replaced by stainless steel
wire or Ti.
 Ideal requirements :
 High spring back property.
 Low stiffness.
 High formability and resilience.
 Biocompatibility and environmental stability.
 Joinability.
 Least friction at the wire bracket interfere.
 To increase efficiency preformed arch wires can be
used in modern appliance.

 Based on material used
 Gold and gold alloys.
 Stainless steel.
 Nickel titanium alloys.
 Beta titanium.
 Cobalt chromium nickel alloys.
 Optiflex arch wires.
 Based on cross section
 Round
 Square
 Rectangular
 multistranded

Elastics are used in orthodontics for a number
of purposes such as closer of space, to correct
open bites, treatment of cross bites and to correct
inter-arch relationship.
The elastic products used in orthodontics
include simple elastics, elastic change, elastic
thread and elastic modules.

The following sprigs are used :
 Uprighting springs :
They are springs that move the root in a mesial or
distal direction.
 Torquing springs :
Which move the root in a lingual or parallel direction.
 Open coil springs :
They are springs that are compressed between two
teeth to open up space between them.
 Closed coil springs :
They are stretched between teeth to close space.

These are used to break the right inter contact.
The different types of separators available are :
Brass wire separators
Ring separators
Dumbbell separators
Kesling’s spring seperator

 Leveling and alignment
 Over bite reduction :
It should precede overjet reduction in order to have a smooth
movement of teeth in the horizontal plane. Deep over bite are
corrected by instruction of the anteriors or by extrusion of the
posterior teeth.
 Overjet reduction and space closure :
There are two types of mechanisms used for anterior retraction.
 Friction or sliding mechanics
 Frictionless or loop mechanics
 Final tooth positioning :
During this phase of treatment smaller diameter wires such as
.016 inches stainless steel or rectangular beta titanium are used as
they are more flexible and allow precise finishing.

FIXED APPLIANCE

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FIXED APPLIANCE