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fixed appliances Flashcards

1
Q

definition

A

an appliance which is fixed to the teeth and can’t be removed by the patient
consists of brackets, bands, archwires and auxillaries
precision tooth movements

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2
Q

advantages of fixed appliances

A

3D control
complex tooth movements
control of root movement
less dependent on compliance

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3
Q

disadvantages of fixed appliances

A

requires excellent OH
risk of iatrogenic damage - white marks
poor intrinsic anchorage - don’t have palate for anchorage

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4
Q

advantages of removable appliances

A

less risk of iatrogenic damage - can clean more effectively

good intrinsic anchorage

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5
Q

disadvantages of removable appliances

A

only simple tooth movements- tipping
no control over root movement
greater compliance required
can be lost

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6
Q

indications for fixed appliances

A 
camouflage (correction of mild to mod skeletal discrepancies)
alignment of teeth
correction of rotations
centreline correction
OJ and OB reduction
closure of spaces/creating spaces
vertical movements of teeth
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7
Q

treatment goal - Andrew’s 6 keys

A

tight approximal contacts, no rotations
class 1 incisors
class 1 molars
flat occlusal plane or slight curve of spee
long axis of teeth have a slight mesial inclination except from the L incisors
the crowns of the canines back to the molars have a lingual inclination

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8
Q

history of fixed appliances

A

1 - bands made individually for each tooth
2 - direct bonding (brackets) - Edgewise.
- have to put bends in wire - time-consuming and challenging
- spaces closed using springs
3 - pre-adjusted Edgewise “straight wire”
- no longer need to pre-bend wire
- arch wire slot individualised for each tooth

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9
Q

components

A 
bracket/tube
band
archwire
modules
auxiliaries
anchorage components
force generating components
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10
Q

components of bracket

A

bracket slot
tie wings
bracket base

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11
Q

bracket materials

A

metal: SS, (CoCr, Au)
polymers: higher friction, not as strong
ceramics: hard to remove post treatment

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12
Q

types of self-ligating bracket

A

passive

active

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13
Q

passive self-ligating brackets

A

reduced friction, wire not held in gap, freely moving to slide

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14
Q

active self-ligating brackets

A

little spring which holds wire in slot
no modules to put on bracket
increased friction so not as good for sliding

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15
Q

how are brackets attached?

A

connected to bands or directly bonded on the teeth

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16
Q

function of brackets

A

hold arch wire in place

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17
Q

bands

A

SS ring which encompasses tooth with pre-welded attachments

- tubes and sometimes lingual/palatal cleats (run elastics)

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18
Q

how do you attach the ortho attachment to the band?

A

weld/solder

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19
Q

where are bands mostly used and why?

A

on molars as need increased bond strength

can also use if a tooth is heavily restored

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20
Q

what are bands cemented on with and what need to be done before placement?

A

GIC

space required - separator visit 5-7 days before

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21
Q

why might pt complain of jag cheeks with a band and how do you treat this?

A

as teeth align surplus wire may protrude distally out of tubes

cut surplus flush with tube

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22
Q

auxillaries

A

supplement main components of bands, brackets and archwires
arch wire hooks and stops, cleats, buttons, coil springs, elastomeric, elastics, separators, wire ligatures, TPA, quad helix, headgear

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23
Q

elastomeric modules

A

secure archwire into arch wire slot

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24
Q

force generating components

A

sliding mechanisms
- elastic power chain (close spaces and pull ectopic canines)
- NiTi coils
- IO elastics
- active ligature
teeth move by utilising the energy stored in the elastic or spring
- pull/push teeth away/towards each other along the arch wire

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25
class 2 inter maxillary elastics
run from U anteriors to L posteriors | e.g. to reduce OJ
26
class 3 intermaxillary elastics
run from U molar to L canine | to pull lower labial segment back
27
what does the bracket prescription determine?
in/out tip torque control
28
what is the MBT prescription modified for?
to make it suitable to treat the most common malocclusion - class 2
29
where on the tooth is the MBT prescription for?
at the midpoint of the facial surface
30
in-out control
relative bucco-lingual position of teeth | e.g. 2 set palatally, 3 set labially
31
what determines in-out control?
depth of bracket base
32
tip
the mesio-distal angle of the tooth - the angle the tooth makes to the horizontal along the line of the arch all teeth tip mesially
33
what determines tip?
angle of the horizontal slot
34
what tooth movements can a round AW achieve?
tipping and vertical tooth movements
35
torque
bucco-lingual angle (inclination) of the tooth - U incisors inclined labially - UBS inclined palatally - all lowers inclined lingually
36
what determines torque?
angle between the bracket base and slot
37
when does torque only happen and why?
when you use a rectangular wire engages wall of slot the closer the fit between the arch wire and bracket slot the greater the degree of control get force couple with interaction between arch wire and walls of bracket - apical and rotational movements
38
composite bonding techniques for brackets and tubes
acid etch technique | self-etching primer (transbond plus)
39
what does the bracket have to enhance bonding?
mesh base to increase SA
40
why shouldn't you really use GI to cement brackets?
decreased bond strength
41
what is GI used to cement?
molar bands
42
how does the arch wire shape change throughout tx?
start round them progress to rectangular
43
arch wire materials
``` NiTi SS CoCr B-Ti (TMA) composite glass ```
44
SS wires
often use early working AWs to slide teeth (low friction) hypodontia/to open gaps - slide teeth to create space (then align with NiTi wire) formable - AW bands, loops multistrand - flexible
45
NiTi wires
flexible light continuous force - low force delivery over large deflection shape memory - return to original shape, difficult to distort higher friction than SS - because surface isn't as highly polished
46
anchorage
resistance to unwanted tooth movement
47
Newton's 3rd law
every force has an equal but opposite reactionary force
48
what is the first aspect of treatment planning?
anchorage
49
why are fixed appliances anchorage demanding?
you are just involving teeth
50
TADs - absolute anchorage
``` non-osseointegrating mini screw won't move under force major development in ortho - anchorage control - tooth movement mechanics ```
51
TADs failure rate
low e.g. comes loose | v few problems
52
how to use TADs
LA then insert between roots
53
uses of TADs
``` retract canine distally (inter-radicular TAD) intrude molars (palatal TAD between 5 and 6s) - close AOB (prev would have required surgery) ```
54
cortical anchorage
cortical plates provide increased resistance to tooth movement - buccal roots start to hit cortical plates as move forward because maxilla gets narrower prevents mesial molar movement TPA and lingual arch maintains intermolar width also transverse anchorage
55
Nance palatal button/arch
utilises palatal vault for anchorage reinforcement stops molars from tipping and prevents mesial drift can potentially further increase anchorage
56
headgear
``` traditional headgear use is in decline sometimes still use protraction gear for class 3 - maxilla more amenable - can disrupt sutures and move forward ```
57
headgear safety
must ensure appropriate safety mechanisms to prevent catapult ocular injuries from face bows - locking devices - safety release springs written and verbal instructions
58
retention
maintaining the final tooth position with a passive orthodontic appliance
59
what is the aim of retention?
prevent relapse
60
types of retainers
fixed | removable
61
consent stage - retention
lifelong retention required | pt decision - wear for as long as you can unless you want to take the risk of relapse
62
features with high relapse potential
``` diastema/space closure rotations palatally ectopic canines proclination of L incisors AOB instanding U lateral incisors ```
63
what type of retention should be given to high relapse risk patients?
bonded retainers
64
PFRs
clear overlay retainers variety of materials and thicknesses can include prosthetic tooth for aesthetics well-tolerated
65
PFRs wear pattern
varies between clinicians 2 weeks full time wear except eating and drinking, night only thereafter or straight to nights only
66
types of removable retainer
PFRs | Hawley removable retainer
67
Hawley retainer
1920s labial bow to control incisors and canines not well tolerated in the L arch can add prosthetic teeth
68
clinical situations for a fixed retainer
``` spaced arch diastema proclination of lower labial segment PD cases (can also use as splinting for mobile teeth) ectopic canines instanding U2s ```
69
bonded wire retainer maintenance
requires careful monitoring and ID cleaning ensure composite attachments intact and sound refer back to orthodontist if problems
70
Orthoflextech
good for L anteriors | cant use for upper incisors as space between composite bonds too big so can get movement
71
rigid canine bars
canine to canine 0.032 inch SS some companies provide preformed maintain IC width so incisors can't move
72
winged retainer
issue if one wing fails
73
types of fixed retainer
bonded wire retainer Orthoflextech rigid canine bars winged
74
risks of fixed appliances
decalcification - monitor throughout tx root resorption relapse gingival recession - esp if pre-existing in adult patient
75
pt journey
assessment and diagnosis - tx aims tx plan and informed consent commence tx
76
average case length
18-24m
77
hypodontia, ectopic canines, orthognathic case length
24-30m but v variable
78
frequency of routine adjustments
every 4-8 weeks
79
initial problems encountered
pain mucosal irritation ulceration appliance breakage
80
GDP role
continue to see pt for routine care and check ups - reinforce OHI and diet advice liase with orthodontist if concerns make appliance safe in case of an ortho emergency - snipping of jaggy wire - removal of loose component

Ortho (21 decks)

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