Fixed Appliances Flashcards
What kind of tooth movements are fixed appliances capable of?
Bodily movement, rotation, intrusion/extrusion, root control
What force is needed for bodily movements on teeth?
50-120g
What force is needed for torquing movements on teeth?
50-100g
What force is needed for rotational movements on teeth?
35-60g
What force is needed for extrusion movement on teeth?
35-60g
What force is needed for tipping movement on teeth?
25-60g
What force is needed for intrusion movements on teeth?
10-20g
What are some advantages of fixed appliances?
All types of tooth movement is possible Allow bodily movement Groups of teeth can be moved Detailed movement possible Essential for dealing with complex cases- ectopic canines, hypodontia, severe crowding
What are the components of fixed appliances?
Brackets Bands/bonded buccal tubes Archwires Ligatures (eslastomeric or stainless steel) Auxiliaries
Where are bands usually placed?
Usually on molars or premolars
Stronger than bonded attachments- headgear, quad helix, occlusal forces, orthognathic surgery
What are the features of bands?
Preformed stainless steel
Buccal attachment welded to band- lower 1 or 2 tubes, upper 2 or 3 tubes
Range of sizes
Lingual cleat sometimes
How do you select a band size?
Separators for one week or less- warn patient re slight discomfort and advise re care/removal
Select correct band (U/L, L/R)
Try in and select a size which is a good fit
It should seat fully but be a neat fit
How are bands placed?
Select band
Dry tooth
Cement using GIC (releases fluoride) and bite stick
Check position- parallel to cusps, fully seated but not over seated
How do you place brackets?
Acid etching- 37%/40% phosphoric acid for 20-30 seconds
Wash and dry- enamel should look frosted, maintain dry field
Bonded with composite and light cured
What is the arch wire sequence of fixed appliances?
Progress from flexible to stiff wire Progress from NiTi to SS wire Initial alignment 0.012”/0.014” NiTi Intermediate archwire 0.020” x 0.020” CuNiTi/0.017” x 0.025” CuNiTi Working archwire 0.019” x 0.025” SS
What are the advantages of the Begg appliance system?
It had 3 stages
It relies on extension
It has good speed of movement
What are the disadvantages of the Begg appliance system?
Lack of precision
What are the advantages of the Edgewise (Angle) appliance system?
Mechanically simple
Precise
Versatile
What are the disadvantages of the Edgewise appliance system?
Slower speed of movement
What are the current fixed appliance systems?
The Tip-Edge appliance- derived from the Begg appliance system
The Straight-wire appliance (SWA)- derived from Edgewise appliance
What are some advantages of the tip-edge appliance?
Permits tooth tipping in early stages
Anchorage saving
Versatile
More precise than Begg
What are some disadvantages of tip-edge appliance?
Narrow bracket with poor control
Requires intermaxillary elastics
Complex in stage 3
Based on extension philosophy
What the stages of treatment with straight wire appliances?
Anchorage management Levelling and alignment Overbite correction/control Overjet correction Space closure Finishing and detailing Initially- round flexible archwires Later in treatment- rectangular archwires
What are some advantages of SWA?
Reduced wire bending- pre adjusted design Use of sliding mechanisms Precision and finishing Flexibility and biomechanics Multiple bracket design
What are some disadvantages of SWA?
Friction
Perceived anchorage demands
Adjustments still required for individual patients
Deceptive simplicity
What is the difference between the original edgewise appliance and the SWA?
Original edgewise appliance required a lot of wire bending- 1st order bends (in/out), 2nd order bends (canine tip), 3rd order bend (incisor torque)
SWA incorporates much of the wire bending into the bracket design
What are the features of SWA brackets?
Stainless steel brackets
Sometimes ceramic
Rectangular horizontal slot
0.018” or 0.022” slot size
As as GDP what can you do if a patient comes in with a missing bracket?
Enquire with the patient about what happened
Risk inhaled- consult A&E for possible chest x-ray
Risk ingested- seek advice from A&E
As a GDP what can you do if the patient complains of acute gingival inflammation close to the attachment or band?
Intensive OHI Disclosing tablets Chlorhexidine gel/mouth rinse Localised scale and polish Contact orthodontist
As a GDP what do you do if a patient comes complaining that their teeth feel loose from their braces?
Reassure
Check for traumatic occlusion
Check vitality/colour/TTP/perio issue
Attend orthodontist
As a GDP what do you do if your patient attends complaining that their teeth feel painful from their braces?
Reassure Analgesia Check there’s no damage to the appliance Check for traumatic occlusion Contact orthodontist
As a GDP what do you do if your patient attends with a broken URA?
If broken clasp remove
If broken acrylic, smooth rough edge
Get patient to attend orthodontist
As a GDP is a patient attends with a loose URA what do you do?
Adjust claps with spring formers
Advise patient not to clock appliance in/out of mouth
Advise to return to orthodontist
As a GDP if a patient attends with a inflamed palate caused by their URA what do you do?
Query Candida infection
OHI and diet advice
Prescribe miconazole oromucosal gel
